Perinatal and Postpartum OCD

by Auti Scolman

Obsessive-Compulsive Disorder, or OCD, is a disorder distinguished by the presence of obsessive thoughts and/or compulsions that soothe the distress brought on by the obsessions. OCD can manifest in many different ways and often revolves around a theme, like contamination, sexuality, harm, or needing things to be “just right.”. A lesser spoken about manifestation of OCD can occur during pregnancy and/or the postpartum period, called Perinatal or Postpartum OCD (-). “Perinatal” refers to the time during pregnancy and “postpartum” refers to the time immediately following birth. The rates of Perinatal/Postpartum OCD range from 7-11% in the perinatal period and typically peak around 8 weeks postpartum. Folks who are pregnant or have recently given birth are vulnerable to developing Perinatal/Postpartum OCD symptoms, especially if they experienced symptoms prior to pregnancy. Although it is normal to feel stressed or anxious about a major life transition like having a child, there are certain markers that can help differentiate expected anxiety and Perinatal/Postpartum OCD. 

Common symptoms of Perinatal/Postpartum OCD:

1. Symptoms that begin or worsen at the time of pregnancy or birth

2. Unwanted, obsessive thoughts about harming the unborn or newborn baby that cause significant fear and distress

3. Secrecy around the experienced symptoms for fear of being judged, hospitalized, or having the child removed 

4. The presence of compulsions meant to control the obsessive thoughts (i.e. excessive checking on the baby, washing, etc.)

5. Avoidance of activities that may cause the baby harm (i.e. using stairs, changing diapers, handling sharp objects around the baby, bathing, etc.)

6. Co-occuring symptoms of postpartum depression (research shows up to 70% of folks with Perinatal/Postpartum OCD have postpartum depression)

7. Overwhelm or obsessional fear getting in the way of caring for baby

8. Needing to have a partner nearby when handling the baby out of worry or fear

9. Issues bonding with the baby because of Perinatal/Postpartum OCD symptoms

10. Trouble sleeping

Why does Perinatal/Postpartum OCD happen?

The occurrence of Perinatal/Postpartum OCD is due to a combination of factors including hormone changes and environmental contributors. The levels of oxytocin and neurotransmitter, serotonin, are impacted during and after pregnancy. Research suggests that an imbalance of oxytocin can then shift levels of serotonin and this may play a role in the development of OCD. Along with hormonal changes, the responsibility of having a child will likely cause increased stress and anxiety. It is important to note that Perinatal/Postpartum OCD can show up in all parents, not just the birthing person. 

How is Perinatal/Postpartum OCD treated?

The treatment for Perinatal/Postpartum OCD looks similar to treatment for OCD and will typically involve Exposure and Response Prevention (ERP), a form of Cognitive-Behavioral Therapy (CBT) that has strong research evidence supporting its efficacy. ERP involves safely confronting avoided situations and lessening the exercising of rituals to manage obsessive fear and worry. Another treatment intervention is the use medicine, particularly selective serotonin reuptake inhibitors (SSRI). Please check with your medical doctor to assess the safety of these medications while pregnant or breastfeeding. 

If you are struggling with Perinatal/Postpartum OCD, please know that you are not alone and there are options out there to support your journey. If You Or Someone You Love Might Benefit From Cognitive Behavioral Therapy (CBT), Acceptance And Commitment Therapy (ACT) For Perinatal Or Postpartum OCD, Or If You Would Like More Information About Our Therapy Services, Please Contact Us At (858) 354-4077 Or At Csamsandiego@Gmail.Com.

Sources:

https://iocdf.org/wp-content/uploads/2014/10/Postpartum-OCD-Fact-Sheet.pdf

https://iocdf.org/perinatal-ocd/

https://womensmentalhealth.org/posts/perinatal-obsessive-compulsive-related-disorders/

https://www.webmd.com/mental-health/what-is-postpartum-obsessive-compulsive-disorder

https://www.psychguides.com/ocd/

A Look Into EMDR

by Auti Scolman

In the world of therapy, several evidence based approaches have emerged to help individuals overcome traumatic experiences and distress associated with Post-Traumatic Stress Disorder (PTSD). One powerful approach is Eye Movement Desensitization and Reprocessing (EMDR). This innovative method has gained significant recognition for its ability to alleviate symptoms related to trauma, and in some cases, certain kinds of anxiety. Let’s dive into what happens during an EMDR session and the benefits that can follow.

What happens in a typical EMDR session?

EMDR is a specific protocol that requires the therapist undergo intensive training in order to become certified. During an EMDR session, a certified therapist will engage the client in some form of bilateral stimulation while they focus on a specific traumatic memory. Bilateral stimulation is theorized to engage and connect the brain’s two hemispheres as it processes the trauma, and can involve moving the eyes from side to side, hearing a tone that alternates between ears, or tapping that alternates on each side of the body. The aim is to access and reprocess the trauma, allowing the individual to create new, adaptive associations and perspectives. In turn, clients strengthen their ability to cope with the emotional distress. 

Benefits of EMDR:

1. Trauma recovery: Reduction in avoidance of reminders of trauma, changes in cognition and beliefs around trauma, reduction in hyperarousal symptoms.

2. Reduction in anxiety and panic: Similar to CBT and ACT approaches, as clients willingly approach the traumatic memory and associated feelings of discomfort including anxiety and panic, they increase their ability to sit with anxiety. With EMDR, the distressing emotions around a traumatic memory typically reduce dramatically on their own through the reprocessing in a single session.

3. Enhanced self-compassion: Clients may find they are more capable of showing themselves compassion, and may begin to reclaim a sense of agency and empowerment in their lives.

4. Accessible care for those who struggle to articulate thoughts: Because EMDR is not an approach that relies on a great deal of talking, clients who struggle to articulate their thoughts may find this modality beneficial.

5. Accelerated healing : EMDR, like CBT approaches, is a short term modality. A typical course of treatment is typically somewhere between 6-12 sessions.

EMDR at CSAM:

Our very own Dr. Terra Fuhr is EMDR trained. She decided to pursue training back in 2017 because she saw several colleagues find great success using EMDR. In her experience, she has found EMDR can help clients break through in places where they may have gotten stuck with CBT approaches alone. She is grateful to have an additional evidence based approach in her tool kit to help tailor treatment to each clients’ individual needs.To make an appointment with Dr. Fuhr, please use our website contact form or call the clinic line at (858) 354-4077.

CSAM IS HERE TO HELP

If you or someone you love might benefit from eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

For more information about Eye Movement Desensitization and Reprocessing, visit The EMDR Institute.

Sources:

https://psychcentral.com/health/emdr-therapy#how-does-it-work

Menopause and Mental Health

by Auti K Scolman

Mood swings, insomnia, hot flashes, oh my! Do these symptoms sound familiar? We’re talking about menopause and the transitional period leading up to it called perimenopause. Menopause can have a major impact on a person’s mental health. During this time, hormone levels fluctuate greatly, leading to uncomfortable psychological and physical changes. The realities of menopause may come as a shock to menstruating people because of the lack of awareness and open communication around the topic. How can someone be prepared for a shift like this if they aren’t given the tools to succeed? Educating mentruators about this mid-life event, its symptoms, and treatments can help smooth the path through this natural transition.

How Menopause Can Manifest In the Mind and Body

1. Mood Swings

2. Anxiety and Depression

3. Insomnia

4. Difficulty with Memory and Concentration

5. Hot Flashes/Night Sweats

6. Changes in Libido

7. Vaginal and Bladder Issues

8. Headaches

9. Bone Loss

10. Changing Cholesterol Levels

It’s only human to look at the list above and feel overwhelmed or discouraged. Rest assured there are solutions to help in the management of the symptoms brought on by “the change”. Both Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) offer beneficial strategies to utilize while going through menopause. CBT helps clients understand the way their thoughts, behaviors, and feelings - including both emotions and uncomfortable physiological sensations - interact and influence each other. Rather than focusing on changing their feelings, clients learn to change their behaviors and the way they think about their symptoms and situation in order to respond more effectively to pain and discomfort. ACT focuses on teaching clients to be more psychologically flexible. This involves teaching clients acceptance and mindfulness skills to respond to their feelings of discomfort, and teaching them to observe their thoughts, all of which are in service of creating space for clients to continue to move toward their personally chosen values regardless of what painful internal experiences arise. Both approaches offer techniques to build empowerment around the obstacles presented during this life stage.

To schedule with Dr. Jill Stoddard, give us a call at (858) 354-4077 or email us at info@csamsandiego.com.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM

References:

https://fortune.com/well/2022/06/15/most-women-are-unprepared-for-menopause/ https://www.health.harvard.edu/womens-health/menopause-rocky-road-to-menopause https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03768-8 https://www.womens-health-concern.org/wp-content/uploads/2023/02/02-WHC-FACTSHEET- CBT-WOMEN-FEB-2023-A.pdf https://www.psychotherapy.net/article/Acceptance-and-Commitment-Therapy- ACT#:~:text=The%20ACT%20interventions%20focus%20around,toward%20living%20a%20va lued%20life.

How Mindfulness Can Enrich Your Life

by Auti Scolman

Mindfulness. We hear that word all the time, but what exactly does it entail? Think of it as the practice of focusing your awareness on the present moment, and acknowledging and accepting your feelings, thoughts, and sensations in your body. In other words, mindfulness is the practice of paying attention to the here and now in a non-judgmental way.

There are so many benefits to practicing this therapeutic technique. Here are just a few:

Respond to Stress and Anxiety More Effectively:

One of the most well-known benefits of mindfulness is its ability to help us cope with stress and anxiety. When we’re mindful, we’re better able to regulate our emotions and handle difficult situations. Mindfulness takes us off autopilot and creates a space from which we are more able to identify our triggers and take thoughtful steps to manage them.

Improve Physical Health:

Research has shown that mindfulness can improve physical health in a number of ways. It has been linked to lowered blood pressure, improved sleep, and a strengthened immune system. It can also help ease chronic pain and other physical conditions that impact your quality of life. 

Enhance Mental Health:

Mindfulness can also improve our overall mental health. It’s been shown to reduce symptoms of depression and improve overall well-being. Many people who practice mindfulness report an increased ability to be present rather than stuck in rumination, a greater enthusiasm for life, and improved self-compassion.

Promote Better Relationships:

When we’re present and aware, we’re able to actively listen and be fully attuned in our interactions with others. This can lead to stronger communication and deeper connections.

Increase Self-Awareness:

When we’re mindful, we’re better able to witness our thoughts, feelings, and behaviors, which can help us make informed decisions that move us toward our values and help us live a more authentic life.

In conclusion, mindfulness is a powerful tool that can bring about a number of benefits to your daily life. Mindfulness, or Present Moment Awareness, is one of the six core processes taught in Acceptance and Commitment Therapy, and is one of the skills that helps increase our psychological flexibility. In other words, it helps us observe and make space for uncomfortable thoughts and feelings so that we’re able to move toward the things that matter most to us. There are a lot of activities that incorporate mindfulness and it may take some time to find what practices work for you. You can try journaling, meditating, or restorative yoga, or simply pay attention to the present moment using your senses—notice what you see, hear, smell, touch, and taste in a non-judgmental way. The key to developing a mindful mindset is consistent effort- you’ve got this! If you would like some support in practicing mindfulness and increasing psychological flexibility, CSAM can help.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS RELATED TO COVID-19, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM

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Reference: 

https://greatergood.berkeley.edu/article/item/five_ways_mindfulness_meditation_is_good_for_your_health

Exercising Your Willingness Muscles

by Annabelle Mebane, MA, AMFT

When you’re someone who experiences a lot of anxiety, it’s easy to end up internalizing unhelpful messages like “you’re too sensitive,” or to think that any time you are having any big feelings, it’s “just anxiety” and that you need to push through or get over those feelings. But a crucial component of learning to respond to anxiety more effectively involves learning to respond more flexibly.

The goal of Acceptance and Commitment Therapy (ACT) – an evidence based transdiagnostic treatment model – is to increase what we call psychological flexibility:

the ability to do what matters most to you no matter what uncomfortable thoughts, feelings, memories, or sensations arise in the process. It’s to accept painful feelings, notice painful thoughts as thoughts rather than always buying into them, and choose to move toward your values even when it’s uncomfortable. Without a solid understanding of values, it might be easy to confuse accepting painful feelings and getting distance from painful thoughts with needing to push through all discomfort no matter what.

But acceptance is not about white knuckling your way through pain,

and defusing from your thoughts is not about writing off all uncomfortable thoughts as “just anxiety.” Yes, anxious thoughts can be unhelpful. Yes, they can get you stuck. But rigidly pushing through all anxiety without getting curious about your pain can be just as unhelpful as rigidly buying into every anxious thought and avoiding anything that brings up those anxious feelings.

Here is the thing: your pain is full of really important information.

Sometimes the way your mind tries to deliver that information is not helpful or accurate. But the pain shows up for a reason. And usually that reason is linked to your values. Sometimes, the reason is that you care so much about something that it hurts. When you care deeply, you risk feeling the pain of failure, loss, rejection, grief, etc. Other times, painful feelings show up to alert you that there is something untenable about a situation, relationship, or context, and to compel you to take actions to protect, advocate for, and take care of yourself.

Acceptance allows you to make space for your feelings, to notice your experience with curiosity and compassion, and to choose how to respond in a way that moves you toward your values.

Sometimes that response involves persisting and acknowledging that the discomfort is likely to come along for the ride as the price of growth and vitality. Sometimes the response involves setting a boundary, saying no, speaking up for yourself, or removing yourself from a situation that is unsafe or out of alignment with what you want or need.

Think of acceptance in the context of working out.

If you want your muscles to grow, you will be required to experience and allow for some discomfort. But there is discomfort that feels like pushing yourself in service of growth, and then there is discomfort that feels like you may be injuring yourself and to persist would actually impede your growth. When we are mindful of our feelings and willing to experience and notice them, we are empowered with important information about how to proceed in a way that ultimately moves us toward our values.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS RELATED TO COVID-19, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM

Making Space for Anxiety

By Annabelle Mebane, MA, AMFT

Often when we seek out therapy for anxiety, we are hoping that with treatment we can cure our anxiety or get rid of it. Anxiety is deeply uncomfortable, and it makes perfect sense to want to make it go away. Plus, anxiety is evolutionarily designed to show up when we are facing a threat, so of course the impulse is to resolve the perceived danger and presumably get rid of the anxiety too.

But the thing is, anxiety also shows up around the things we care most about.

When we take a risk towards something we care about, our minds and bodies sometimes read that risk as a threat. It’s vulnerable to care and to risk feeling pain, rejection, loss, or failure. And if we “resolve” that threat and make the anxiety go away, that sometimes means we are cutting ourselves off from the richest parts of our lives. We avoid taking the risks that may cause pain and that will very likely cause anxiety, but in doing so, we miss out on the juiciest parts of life.

The primary goal of anxiety therapy isn’t actually to get rid of anxiety.

As someone who has experienced (and still experiences at times) a fair share of anxiety, and someone who is also now a therapist specializing in the treatment of anxiety disorders, I’ve learned that the most effective treatment for anxiety isn’t ultimately about getting rid of anxiety. It’s about learning to make space for it to be there, and still choosing how we want to show up and respond to it.

I know that sounds really hard, and it is. One of the hardest parts of anxiety is the way that it can get us stuck. The way it convinces us we can’t handle the challenge in front of us or the feelings showing up inside of us. The way it convinces us to make ourselves or our lives smaller in order to try to stay safe or comfortable.

So how do we make space for anxiety?

Making space for anxiety looks like slowing down, noticing our heart is racing, our palms are sweating, our head feels light, our body feels tingly and shaky, naming that we are feeling anxious or nervous, and compassionately saying to ourselves “yep, this takes courage for me to be here and do this right now”. It looks like noticing that our mind wants to beat us up – “seriously, you’re still anxious about this?” “other people don’t have this much trouble with this,” “why are you so sensitive?” “you can’t do this,” – noticing these are painful stories, and responding to our mind compassionately, the way we might respond to our younger self or our child.

How do we choose how we want to show up even when we feel anxious?

Choosing how we want to show up means that we decide what matters to us most in this moment, we clarify how we want to behave in this moment, and we do our best to take action toward those values. We don’t get to choose if we feel anxious. We do get to choose if we are going show up and how we are going to respond to ourselves and others when we do.

• Maybe it means going in for your annual check up in service of taking care of your health, and showing up to that appointment as someone who is assertive, compassionate, present, and grateful.

• Maybe it means donating blood in service of giving back to your community and in service of facing a long held fear of needles, and showing up as someone who is open, brave, and willing.

• Maybe it means getting on a plane to fly halfway across the world to attend the funeral of a loved one, and showing up to connect and share love and grief with family.

• Maybe it means joining a dating app, going on a first date, and showing up as someone who is playful, kind, and authentic.

• Maybe it means getting behind the wheel in service of being independent, and showing up as someone who is determined and perseveres.

We choose the action, we choose the qualities of being, and then we do our best and have compassion for ourselves if it doesn’t go exactly as hoped or planned.

Making space for one feeling often makes space for others too.

When we make space for anxiety and stop fighting with it and beating ourselves up for having it, sometimes we also make space for the possibility of a complex experience that includes both anxiety AND joy, connection, love, or pride.

Even as an anxiety therapist, there are some things that I personally just either haven’t yet or won’t ever completely stop feeling anxious about. But whether that anxiety ever goes away completely doesn’t matter to me anymore. If I know I can show up anyway, that’s all I need to know. Sometimes the fact that the anxiety shows up and I still do too is actually part of what makes it meaningful.

I get a choice to be brave and vulnerable, and when I’m not stuck trying to wrangle my way out of the anxiety, I get to make space to also notice and sometimes relish the other feelings I’m having. Most of the best, most meaningful and important moments of my life have come right after feeling an almost overwhelming amount of anxiety and choosing to show up anyway. And from an Acceptance and Commitment Therapy perspective, we hurt where we care. And caring is not something we aim to get rid of, so we make space for the pain and anxiety instead.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS RELATED TO COVID-19, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM