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

Busting OCD Myths and Misconceptions: OCD In Its Many Forms

By Annabelle Parr

The term OCD has been appropriated to describe neat freaks, those who get a kick out of organizing, and the Mr. Cleans of the world. People casually joke “I’m so OCD!” in reference to their color coded planners or their squeaky clean cars or their Instagram worthy closets. Not only is this use of the term inaccurate, the tongue and cheek expression minimizes the severity and suffering associated with obsessive-compulsive disorder (OCD). 

For those who actually meet diagnostic criteria for OCD, the characteristic obsessions and compulsions are far from cute or funny. According to the DSM-5, obsessions are intrusive, unwanted thoughts, urges, or images that create immense anxiety and distress; compulsions are the actions the individual takes to attempt to neutralize, suppress, or ignore the obsessions, and involve behaviors or mental acts which are rigidly applied in response to obsessions. OCD compulsions take up at least an hour of the individual’s day, and create serious impairment in important areas of life, including school, work, and relationships.

Additionally, although most people tend to think of OCD as characterized by fears of germs or the need for things to be orderly, these are only two of many manifestations of the disorder. There are a number of categories into which obsessions and compulsions commonly fall, including checking, contamination, symmetry and ordering, and intrusive thoughts. These categories often overlap with one another and at the core all subtypes involve extreme difficulty tolerating uncertainty. 

Checking

Though the checking behavior is a compulsion, the compulsion is driven by a fear-based obsession regarding potential harm or damage that could occur if the compulsion is not engaged. Some examples in this category include checking locks, appliances, lights, and taps, checking for signs of illness or pregnancy, checking one’s valuables, or checking for signs of sexual arousal, as well as seeking reassurance. The checking behaviors – like the compulsions in all of the subsequent categories – are engaged multiple times, and often prevent one from maintaining commitments such as arriving to work on time, keeping social engagements, etc.

Contamination

In this category, the obsessive fear is related to harm as a result of being dirty or coming into contact with germs, and the compulsion typically involves excessive cleaning or avoiding situations which may result in contamination. Some common examples of feared stimuli include public or private toilets, restaurants, shaking hands, chemicals, sex, outside air, and crowds. 

Symmetry and Ordering

The obsessive aspect of this category can either be related to the compulsion, where a lack of order causes great discomfort, or can be connected to other unrelated fears or intrusive thoughts such that the compulsion to create order is believed to prevent the feared harm (e.g. contracting a serious illness) from occurring. Items – such as clothes, books, pictures, and food – must be arranged symmetrically and just right.

Intrusive Thoughts

This particular subtype is sometimes referred to as “Pure O” (for obsession), as it is characterized primarily by obsessions and avoidance, but does not typically have overtly obvious compulsions present. Intrusive thoughts are a particular type of distressing obsession, characterized by involuntary, unwanted, highly distressing and often disturbing thoughts. 

Intrusive thoughts can be related to one’s relationship, where for example, one feels the compulsion to constantly seek reassurance of one’s partner’s feelings or faithfulness.  

They can be related to sex, involving intense fear of being sexually attracted to children, sexually attracted to family members, or regarding one’s sexual orientation.

Another particularly distressing form involves intrusive thoughts regarding violence, where one fears he will carry out violent acts toward himself, loved ones, or others.  

Sexual and violent intrusive thoughts are experienced as especially disturbing, and individuals struggling with these thoughts are often hesitant to disclose them as they may believe that these thoughts are a sign that they are capable of such actions; they may also fear that these thoughts mean that they are a bad person or that they will be viewed as such. Despite the disturbing nature of these thoughts, individuals with OCD are the least likely to act on such thoughts, as they experienced as revolting; rather than indicating a propensity to carry out these actions, much of the individual’s time is devoted to suppressing the thoughts and avoiding and preventing the feared outcomes.

Intrusive thoughts can also come in the form of magical thinking, where the individual believes that thinking about something terrible – such as a natural disaster or death – makes it more likely to occur.

Finally, religious intrusive thoughts (scrupulosity) can take the form of intense fear that one is sinning, one must pray over and over, fear of blasphemous thoughts, etc. 

OCD Treatment

The good news is that effective treatment is available for OCD. The gold-standard of treatment is currently Exposure and Response Prevention, a form of Cognitive Behavior Therapy in which the client is – in the context of a warm and supportive therapeutic environment – exposed to the distressing obsessions and prevented from engaging in the subsequent compulsion. Like all forms of exposure therapy, this approach allows for new learning to occur such that the association between obsession and compulsion is slowly broken down. The client typically learns over the course of treatment that catastrophe does not strike despite failure to engage former compulsions. Medication may also be recommended in conjunction with therapy in some cases.

OCD Is No Joke

OCD can severely limit one’s ability to engage effectively and meaningfully in life. The associated distress and anxiety can be overwhelming and painful, thus OCD is not something to joke about or trivialize. However, with effective treatment, individuals can learn how to manage distress in new ways such that they are not prevented from engaging in a rich and vital life.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com