We hosted our first live webchat in April when Professor Paul Salkovskis from the Institute of Psychiatry offered to take part in the webchat to answer some of the many questions that were being asked following the huge success of the Five OCD documentary shown in January.
So
on Monday April 4th, OCD-UK’s Nathalie Davenport and Ashley Fulwood,
armed with their laptops, went along to visit Paul in his office at the
Maudsley Hospital in London and hosted the first of what we hope will
be a series of similar events.
Questions were submitted by visitors to the website and we offer our extreme gratitude to Professor Salkovskis for staying behind after an already busy working day to complete the webchat. In the end we answered every question submitted despite running over time.
Many thanks for your participation, the response was tremendous with some great, insightful questions. We hope to repeat the exercise with other guests later in the year. We recommend that if you have specific concerns about OCD that you consult your GP.
(We recommend you start reading from the bottom question, upwards.)
Finally
Paul: Finally; Ashley, Natalie and I are tired but happy sitting in a darkened Institute of Psychiatry room, hunched over keyboards! It’s been a pleasure talking to you all. Thanks
From Karen
Dear Paul
I am 36 and married with 2 young children and i've had OCD for years and IT rules my and my families lives!! My concerns is about contaminating and germs especially from shoes, clothes, floors especially carpets, animals, birds and people!!! It's all about contamination and bringing 'them' into my safe and clean house or car etc. It's an absolute nightmare. My elder son, who is nearly 5 had to get changed when he comes in from school then I have a huge cleaning schedule following and that's 5 days per week. When we buy clothes, I have to wash them first and cant even try them on till I have done so. We can do normal things like going to the cinema or restaurants that have cloth seats as I fear from contamination. Everything is a challenge. Even hanging clothes outside to dry is awful and my sons school clothes get washed twice every day. Paper is another problem. Receiving post is another challenge daily and I look forward to Sundays as there's no post. When I go food shopping every single thing has to be wiped with an antibacterial wipe then dried before I put them away. My son's school books have to be wiped (ever page) which doesn't take too long now as he's only 4 coming on 5 but god knows how i will cope when he brings novels etc back!! I want to get better for the sake of my family plus myself as I would have so much more time for my sons.
There so many things that I could go on forever but don't want you to fall asleep whilst reading this.
Anyway, my main reason for contacting you is to ask how I can overcome this when, to ME, the consequences are very real to me if I don't do the endless cleaning. I have read various forums that say that 'it the OCD telling me that, for example, my house will be contaminated if I don't do it, but to me it's seems obvious that my house will become contaminated if I don't clean, for example when my son comes in from school (he sits on carpets etc at school therefore it is a problem to me, though I don't let him know, he doesn't get the quality time he deserves when he comes in from school as I am cleaning!!! Sorry for going on and on!! How can I get over this if the consequences are real to me, that's my main question. It's taken a long time getting there but that's it!! Thanks in advance for your help and patience with me rattling on and on!!!!
Take care
Karen
Paul's Reply: It sounds like sheer torture, and that’s a key point. Of course the consequences are real to you, otherwise you wouldn’t be driven to do these things. However, the consequences are two sided, aren’t they. There is the possibility of contamination which has, as its flip side, the certainty that your life (and, I suspect that of your loved ones) being spoiled or even ruined by your OCD. Now that in itself will not help you get over the OCD, but it should make you think very seriously about trying to get some sensible help for this problems which is obviously destroying your happiness and hopes. By the way, just to mention to you and other mothers of young children, we are running a workshop on the 23rd April entitled
“SUPERMUMS IN THE MAKING: FIGHT YOUR OCD AND STILL BE A GREAT MUM”
details on:
http://www.iop.kcl.ac.uk/iopweb/departments/home/default.aspx?locator=768
We’ve never done this before, and we are hoping to learn from this ourselves. Bottom line given what you say…..find a good therapist who will help you begin to see things differently.
Obsessions about 'thought'
Subject: Obsessions about 'thought'
Dear Professor Salkovskis,
Is it common for OCD sufferers to have obsessions about 'thought' itself, or about 'why' we do things? I suppose obsessions can be about anything and everything, so it is probably better to analyse general beliefs about thoughts than endlessly 'correcting' individual obsessions.
Paul's Reply: Yes; sometimes called “being obsessional about being obsessional”. Questioning your motivation is a type of trying to discover more than we can possibly know. You are right about the need to make sense of general beliefs (and think about what new beliefs you might want to have). Natalie and I both talked about this above. Obsessions can’t be corrected; it’s like trying to argue with an automated telephone answering service.
Treatment: An Ideal - From Caramoole
Subject: Treatment - An Ideal
It is interesting to read your replies and it would be wonderful if in practice the quality of treatment, as offered by your department, were freely available nationwide to all sufferers. Sadly the reality is very different. Most sufferers, if they're lucky enough to get a referral, would have to wait a minimum of 10 months even to see a therapist and then it's very hit and miss whether they have a good knowledge of OCD. If we are to believe the stats, that say OCD is thought to be suffered by 2-3% of the population, in an average town there would be approximately 4 to 6k sufferers. It's a staggering number and would almost warrant a specialist unit in each town, certainly in each region and it's not going to happen. The numbers of Clinical Psychologists alone would never be achieved, not to mention the funding!! As a volunteer on this site I try to do my bit, we already over 900 users and it rises daily, it's humbling to see the distress, we try to support and advise, it's a wonderful resource but can't do the job that should be done.
Can you ever see a time when 'Excellent' treatment is available to all, at least in major Cities like Leeds, Manchester, Birmingham, Glasgow etc or are sufferers doomed to a little support and a lifetime of medication because the services aren't available, or do you feel it will change?
Hope that's not too political ;)
Paul's Reply: Ashley, Natalie and I are all sitting here agreeing with you. And of course the point applies not just to OCD but also to other anxiety disorders
However, I don't feel totally pessimistic. There are a number of bullets
to be bitten, problems to be solved and systems to be put in place. Starting
with the systems: the idea of stepped care is an obvious and untried one.
People early in the development of their problem should be offered high
quality focused/brief interventions, e.g. good guided self help; with
more severe and chronic problems, specialist therapists who have had appropriate
training. Training does not have to take years at this level. And so on
down to specialist national units such as our own (to deal with complex
problems....problems not cases). Stepped care.
Then there is the problem of c**p therapists, or good therapists offering
c**p therapy. Think of how many people are offered the wrong therapy in
the wrong way. We (the health service, universities, training courses)
still churn out a majority of therapists who believe that psychodynamic
or some other silly therapy is the right one to use for OCD. This is a
waste of time and resources for all. There are some hard decisions to
be made by the health service; hard for therapists at any rate. The NICE
guidelines are actually the start of progress toward that kind of end.
So yes, I can, providing we have the will to make it happen, provided vested interests such as private practice, professional guilds and big pharma don't get in the way.
Triggers - From Sian
Hi there i was just wondering if you know what triggers ocd? I had a very traumatic childhood and i was just wondering if that might have caused it.Also my dad i suspect has Aspergers and (so does my brother) could the two be linked?
Many thanks
Sian
Paul's Reply: I previously described this as the Nobel prize winning question. The reality is we don't know. It is almost certainly "multifactorial" (lots of different things involved), which would put it in line with depression and other anxiety disorders. We have written about (and are trying to research) a range of factors which we think are involved, which include "parentification" (being made responsible from young age), not being allowed to be responsible at all when younger, over-strict codes of moral conduct, bad stuff happening when you thought you were responsible (e.g. wishing someone would die then they die...aargh!), doing something which unintentionally contributes to harm and so on. The ultimate cause of OCD, in my view, is BAD LUCK, a much underestimated factor in psychological problems.
Question about Diet from Ashley
Subject: Diet
Does diet play a part in OCD?
Paul's Reply: It's not clear. There were some reports years ago that some people benefited from an exclusion diet (Lamb and pears!) suggesting a possible role for food allergies, but this faded away. What is certain is that having a balanced diet is certain to be beneficial if you don't have one now! Supplements are always worth a try in moderation, whether vitamin c or fish oils.
Catholicism and OCD
Is there any evidence that Catholicism encourages Obsessive-Compulsive behaviours - i.e. repeating phrases (Hail Marys etc.). Is there a higher incidence of OCD among Catholics than Protestants/other religions?
Paul's Reply: No. What appears to happen is that extreme teachings in any religious or moral system may set vulnerable people up for OCD. We have seen Muslims, calvinists, sikhs, hindus, and buddhists. In principle, I can imagine having a satanist seeking help (Doctor, I have these really unpleasant and unacceptable thoughts that God is good....I have to swear at them to neutralise them, but they just keep on coming back). Seriously, it is possible.
OCD Causes from Matthew
Subject: OCD Causes
Do you think OCD is hereditary, or learned?
Paul's Reply: Mainly acquired (not quite the same as learned) with a possible genetic vulnerability (meaning that some people are predisposed, but probably to anxiety rather than OCD. Genetic contribution is hard to quantify but probably less than 10%. It may be less, it may be more, because the research is pretty lousy. Simply speaking OCD is not inherited, otherwise identical twins would be fully concordant for it, which they clearly aren't.
OCD Treatment from Jo
Subject: OCD Treatment
Dear Dr Salkovskis,
I watched with great interest the channel 5 documentary about OCD in January, which included showing sufferers undergoing treatment with you. One of the types of OCD which I suffer from is 'contamination OCD' and I wondered if you could reassure me that the type of exposure I saw both you and the sufferers undergoing is safe or not. By that, I mean that the programme helped me a lot in that I saw that you were not taking all the 'precautions' that I would necessarily take and you are seemingly fine from that, so I wondered if you could reassure me that it's safe to do what you were doing?
Thanks,
Jo
Paul's Reply: Hi Jo. The Channel 5 programme, although excellent,
was of very brief contact and of necessity didn't show the way treatment
unfolded.
In terms of my safety, I'm fit and well, perhaps a little overweight but
in all honesty I can't blame that on my work with OCD!!! By definition,
if you contaminate yourself with anything the risk goes up. My risk of
developing a stomach problem went from, say, 1 in 10000 to 4 in 10000
by doing what I did. Notice that the reason I "toilet dipped"
was not so that Katie could do it too, but so that she could take a crisp
from a packet with her hands....which she managed as a first step in normalising.
She also increased her risk by taking that crisp. Now set that risk against
the risk....no, I mean the certainty, that her life would be severely
damaged by her OCD, and you get a different perspective. Think of it like
driving. I drove on the M25 today, and increased my risk. I took that
risk because traveling on public transport would have been much more of
a problem, so there was a cost benefit analysis. Sometimes, with OCD,
the cost benefit analysis gets out of balance, and needs re balancing.
You need to think about my motivation; why do I do the things I do (even though they increase my risk)? The answer is that I know that it will help, and its worth that for me. How much more is it therefore worth for Katie (in the ch 5 film). However, it is always the choice of the sufferer. One of the first things we always say is that we might ask the person to do things, but "no" is always an acceptable answer. All we ask is for permission to try to persuade the person, help them see why they need to try and so on.
In summary; contaminating yourself might slightly increase danger, can't deny that, but the REAL danger is not a risk...that's the danger that OCD will destroy your life
Ashley: Do you think asking OCD patients to do something a non sufferer would not do, like putting their hand down a toilet is an acceptable treatment strategy?
Paul's Reply: Absolutely, yes. Sometimes, if you want to get
back to normal you have to do abnormal things for a while.
Think of it this way. If you broke your leg, you would probably have to
wear a plaster cast. "But.." you splutter to the doctor "why
should I wear a plaster cast? It's certainly not normal to wear a plaster.
Why, if I go into the street just now, probably no-one else will be wearing
one". Similarly, if you are height phobic, you may simply wish to
visit your gran on the 3rd floor. However, spending an hour up the post
office tower (Blackpool tower if you are from the north and the Scott
Monument if you are even more northern) will mean that you won't even
be vaguely nervous when you go visit your Granny. However, if you had
confined yourself to getting used to the third floor......
OCD and Sleepwalking from Patsy
Subject: OCD and Sleepwalking
I have OCD and have many obsessions. Although I never have 'sleepwalked',
one of my main obsessions is that I might 'sleepwalk' and do something
that I have no control over. Is this common and how can I confront this
fear? It's not as though I can expose myself to the things that I worry
about doing.
Patsy
Paul's Reply: Some varieties of this are common; see the previous post about the possibility of doing things when drunk. You don't necessarily have to confront your fear....you just need to see it for what it is. If you take precautions, seek reassurance, set traps for yourself, then you can confront it by stopping that stuff, eating cheese ;-) and so on. In the end, though, it sounds as if you need to work on the meaning....what kind of out of control? why does it matter? (for example).
Thoughts feeling real
Subject: Thoughts feeling real
I guess my question is: IF SOMETHING FEELS REAL, HOW DO YOU KNOW IT'S NOT?
I struggle with thoughts connected to specific situations with my children, e.g. breastfeeding, where I am performing an activity/ a movement and then I have a thought that I am performing the movement on purpose or for an inappropriate reason, usually a sexual reason. The problem I have always had with these thoughts is they happen so quickly, and the moment I have them it is as if the thought is real and I genuinely feel as if I must have performed the action for a certain inappropriate purpose and genuinely cannot tell what I did for what for reason. These situations are different to having thoughts only that I know are just thoughts.
Paul's Reply: The thought is real, but the question I think you are really asking is not whether the thought is real, but whether or not it means what you fear it might mean. The feeling of guilt/discomfort is also real, but does not mean what you think it does. Let me give you an example. When I go through customs (perfectly legal) and the customs guy stares at me, I feel guilty. Is that a real feeling? Yes. Is it based on wrongdoing? No. It relates to my worries/worst fears. Part two of the problem comes when you (understandably) try to convince yourself that you were not feeling sexually excited or whatever. But how is it possible to be sure of what the feeling really meant? Some people who have this kind of thought then try to work out whether or not they have any signs of sexual arousal, and either think that they might find some (commonly) or cannot be sure that it is not there. Again, this is the OCD. As said above, your thoughts focus on your worst nightmares, and you cannot (nor can any of us) be 100% sure that our worst nightmares are not true. What we can be sure of is that OCD has got us in its claws. Isn't that 100% certainty?
Treatment options from Denny
Subject: Treatment options
Hi
On the OCD-UK Bulletin Board, we are hearing great things about the treatment
offered as part of the forthcoming Channel 4 programme. So a few inter-related
questions Was the treatment an intensive form of CBT ? How long did it
take ? If it is deemed to be successful, how can others access it ? Are
you offering a similar form of treatment to others at the Maudsley - either
via the NHS or privately ? Can you roll it out across the UK?
thanks
Paul's Reply: The Channel 4 programme was a fantastic experience,
and has made our team begin the process of rethinking how we do intensive
CBT (yes, it was intensive CBT). We have never done it on a residential
basis of this kind (i.e. not hospital) and it clearly both de-medicalised
the problem (which was really helpful) and mobilised mutual support between
the participants at a level which exceeded our expectations. It took two
weeks, but in reality it was less than that, because there was quite a
lot of faffing around with cameras and waiting while technical hitches
were sorted out. That being said, the agreement was that once therapy
got going cameras were not to interfere, and the film folk were magnificent,
became part of the team from time to time. I think we did about five days
work in the house, the participants went home in the middle and implemented
what they had learned.
We offer intensive treatment as outpatients in our clinic (the Centre
for anxiety disorders and trauma) but not on exactly the same basis. "The
OCD house" was an experiment, clearly a very successful one, with
3/3 participants free of OCD at the close and I'm pretty sure they still
are. We only offer treatment through the NHS, as I am opposed to making
people pay for treatment when they are so desperate. Also I don't think
that people should get better or faster treatment because they pay. Enough
of my political views.....
I'd love to research the concept as it was used in the project, comparing
it to our "standard" intensives. We shouldn't roll anything
out until we have good research evidence that it is better than the best
available alternatives. The grim fact is that the best available alternatives
have not yet been rolled out across the UK, with some awful c**p out there
masquerading as CBT. There I go with the political views again...
Ruminations of blasphemous thoughts frm Sue
Subject: Ruminations of blasphemous thoughts
Dear Prof.
I want to ask you about ruminations of blasphemous thoughts, and what
treatments you recommend. Also is it common to have different forms of
OCD over a number of years, and also happening at the same time.
Thanks
Sue
Paul's Reply: Although researchers and clinicians like "categories"
(checking, washing, ruminations, hoarding) the reality is that life just
isn't like that, and people have mixtures. There are people who stick
to just one worry, but it is more common to have multiple concerns and
problems. These are sometimes called "complex cases"; as I described
in a previous post, they are better thought of as complex problems. It
also turns out that "complex" is only complex if the pattern
is not understood. Understanding, and making sense of things, is crucial
in my view to being able to deal with your OCD. Ruminations (blasphemous
and others) are best dealt with by CBT which takes account of both the
meaning of the intrusions and helps you deal with the neutralising (e.g.
mental rituals, mental argument, thought suppression [trying to push thoughts
out of your mind] and so on)
There is some more on this in some of the other posts
Nathalie's Reply: What is important about the question you pose as well is how clearly it relates back to Paul's earlier point about the need to challenge general beliefs and/or compulsive drives in order to develop long-lasting and effective strategies for dealing with any, of OCD's many canny mutations.
Antidepressents from Randall
Is it possible that patients might respond to lower doses of antidepressents than higher ones? It seems a lot of psychiatrists find something that works partially and feel that the ever increasing dose is the answer.
Paul's Reply: Not really my area of expertise (I'm a clinical psychologist and therefore don't prescribe medication). However, I do follow the research, and am often called upon to advise about this type of thing. Bottom line: if medication is prescribed it should be in the effective range, and it is sensible if there is good evidence of a response to raise it to higher levels. However, evidence of a response should be systematically gathered; seeing someone for five minutes once every month is not, in my view, a good way of making such judgements. The sufferer can, of course, keep careful track themselves, for example by using diary records (length of wash/check, distress) on a daily basis, or using questionnaires of the type used in clinics, then presenting the clinician with the results. Take control yourself, have an opinion, and share it with the person who is supposed to be working with you. If they don't like it, bin them!
Ocd and Hynpochondrias from Sammy
Subject:: Ocd and Hynpochondrias
Hi,
Do you think sufferers with hypochondrias can ever be free of thoughts and fears? I have this severely most days, and although I work full time and maintain a normal life i do feel so painful mentally every day.
Paul's Reply: Well, mention health anxiety in the last one and here it comes! Health anxiety is treatable, again with CBT. There are several randomised controlled trials. The bottom line is understanding how health anxiety works, what keeps it going and so on. There are similarities between OCD and health anxiety in terms of checking, reassurance seeking, avoidance and so on; all of these are involved in keeping health anxiety going, and the person has to be helped to deal with them as part of an integrated treatment plan
Depersonalisation from A Martin
Subject:: Depersonalisation
Hello Mr Salkovskis
I would like to ask a question if that's ok
Its not to do with OCD, but Depersonalisation. I do know there is a specialist depersonalisation Unit at maudley Hospital, but was wondering if you could tell me of any organisations in Manchester area where specialise in DP? National Phobic's Society used to do a helpline, but no longer available
Thanks
A. Martin
Paul's Reply: Oh dear I wish I knew. I don't think there is a
specialist unit elsewhere. However, that being said, I'm not of the opinion
that depersonalisation necessarily requires treatment by a specialist
unit, just by someone who knows what they are doing and is a decent enough
person to mean that you can trust them. Actually, in Manchester you have
some great CBT folk about (if you can winkle them out). Depersonalisation,
in many instances, responds well to the type of treatment used for Health
anxiety (what doctors call hypochondriacs) or panic disorder.
Nathalie: Could you clarify, Paul, what the term 'Depersonalisation'
means?
Paul's Reply: Depersonalisation and Derealisation are when the person has a range of feelings, including the feeling that they themselves are not real (depersonalisation) or that their surroundings are not real (derealisation). It often goes with fears that the feelings might be going mad, have a brain tumour, going to stay that way forever and so on. Sometimes it's linked to "dissociation" which is where it feels as if your feelings are distant or unreal.
Responsibility OCD from Waul
Subject: Responsibility OCD
Dear Paul,
I was wondering what you thought was the best way to deal with 'Responsibility
OCD'? I suffer with OCD and am embarking on a career in health care and
already I am ruminating and recalling the events of the day! Questions
keep entering my mind such as; 'could I have done more etc! Do you think
a cognitive approach is best here? although isn't it bad to get into a
debate with OCD? How about listening to loop tapes to expose myself to
the worst case scenario's?
many thanks, Waul
Paul's Reply: Actually, all OCD is responsibility OCD in my opinion. Intrusive thoughts, images, impulses and doubts are taken by the sufferer as meaning that they must react in order to makes sure that harm has not happened, prevent it or undo it; harm can be to oneself or to other people. Blame is linked; blame is responsibility for past harm. It is the idea (meaning) of harm which "bridges" the gap between an intrusion and the urge to neutralise/ritualise/check. People who don't have OCD have the same intrusions as those who do, its just that they don't attach responsibility meanings to them, so don't neutralise and get stuck in the vicious circle of intrusions>responsibility misinterpretations>neutralising>increased responsibility meanings.
So; cognitive therapy is about changing meanings and is appropriate.
However, the problem is that reacting to doubts ("did I do the best
I could today?" or "am I certain that the gas is turned off?")
by some version of "Yes, of course I did" will usually end up
as a type of neutralising, making things worse, not better. Cognitive
therapy is about changing the meaning of intrusions, not the intrusions
themselves. Ultimately, the idea is to be able to see them as either mental
"flotsam and jetsam", a kind of mental wind or as things which
reflect one's current concerns rather like dreams can.
Think about dreams; these are essentially the nighttime equivalent of
intrusive thoughts. They can be hugely upsetting, but usually we don't
let them change what we do the rest of the time. Trouble will only follow
if you try to rule your life according to your dreams rather than thinking
about them as "background noise" from your mind.
Loop tapes (something I introduced way back in 1982, would you believe,
brag brag) only really help when used as part of a therapist (or self)
directed BT or CBT treatment. Part of their value is so that particular
intrusions begin to blend back into the general "noise" of mental
activity; they are also a great way of identifying "mental rituals"
in an on-line way.
CBT and "bad" thoughts from Kerry
Subject:: CBT and "bad" thoughts
Hello,
After some hypnotherapy sessions I am currently waiting to restart CBT, I had hypnotherapy to help me deal with anxiety attacks that had increased significantly since starting CBT. I have a small son and found that I was unable to cope with facing the OCD and anxiety and behaving in an appropriate manner in front of my son.
I understand how CBT can help me overcome my compulsions but I still feel unsure how it will help with the thoughts. I have quite disturbing thoughts and images which I find abhorrent. Over the past 6 years various therapists have helped me reduce the anxiety attached to these thoughts, I can cope with them now but ideally I would like to be rid of them. There are still some that no matter how hard I try cause high anxiety.
I don't feel entirely satisfied with my therapist at the moment but the waiting list here is so long that I wouldn't want to risk changing, there are 2 NHS CBT therapist in the area.
Could you give me an idea of how successful, if at all successful CBT is at reducing these horrid thoughts rather that just the anxiety. Part of me feels safer being just abit unnerved by the thought because the idea of not being would make me wonder if I actually enjoyed them and that would be worse.
Many thanks
Kerry (OCD UK discussion board username Twoshoes)
Paul's Reply: Intrusive thoughts (ruminations) are best dealt with using the cognitive bit of CBT. The key is understanding how these thoughts happen, and why they matter so much to you, then being able to see them in a different way. The point (often made, and you obviously know it well from your post) about not getting rid of your thoughts is that the only way to stop having intrusive thoughts is to stop having thoughts at all! You, like me and most other people, have thoughts popping into your head that you don't want. However, pause and reflect what your intrusions really mean. Really mean. Here's a quiz to try to help. I have seen people who are troubled by blasphemous thoughts. What kind of person do you think they are?
Right, they are religious. Very religious.
Thoughts of harming their child?
Right, a loving parent.
Thought of violence to strangers?
right, a pacifist, gentle soul.
So the thoughts that pop into your head are like worries. What do I worry about? The worst things that could happen, of course. Does that mean I want these things to happen?
And so on.
There's a lot more to it in good CBT, but in the end the key thing is that you need to find out (not just be told, but be helped to find out) that the best way to control your thoughts is not to try. Boy, is that a tough thing to do. I suspect we will have a lot more on this topic...
Nathalie: Ok, so if we are able to tackle the fear that these thoughts precipitate and the distorted level of significance we attach to them, can the frequency of these thoughts also be reduced, brought down to a base line level. i.e. will sufferers of pure 'o' always get more intrusive thoughts/images than the average person even if they are no longer as terrified by their content?
Paul's Reply: Thanks for bringing me back on topic! The reality
is that, once you are able to give up fighting the thoughts, they will
head south, meaning they will become less and less common. However, Natalie
caught me out here, because I'm very keen not to make it the point of
what you are trying to do. If you keep monitoring the thoughts to see
if they have gone back to normal in terms of how often they occur, then
monitoring them will make them come more often, and a (lesser) vicious
circle continues. If they really really don't matter, who cares whether
they come or not. It's like thoughts of rhubarb pie don't matter to me
right now. But if I decide that thoughts of rhubarb pie are really really
serious, then I will be wary of them and bingo!!
So the answer is that the thoughts will go away, but don't try to make
them do so, because that ends up being counter productive. OCD is a tricky
little devil, isn't it?
Bad thoughts about family
Subject:: Bad thoughts about family
Hi in OCD is it normal to think in your head your wish/hope/want/pray bad stuff to happen to your family and the closest people to you? You really don't mean it but end up thinking of ways and times and stuff? Thanks so much for your time it is greatly appreciated.
Paul's Reply: If by normal you mean it happens a lot, yes is the answer. It's like other types of intrusive thought; you are bothered by the thoughts you don't want to have. For some people that's harm coming to those they love, for others its themselves wanting harm to come to those they love, and goes with thoughts like "what kind of person would have thoughts like that". The correct answer is, of course, the kind of person who hates having thoughts that they might want harm to come to those they love; that is, a loving kind person who is misunderstanding the way they think, because they are sensitive (and loving)
OCD and Alcohol
Subject:: OCD and Alcohol
Hello Dr Salkovskis
My OCD (for the last 3 years) has centred around the worry that I may have abused a child whilst drunk-there is no concrete evidence to suggest this is true, but my OCD says "Ah, but you were drunk-how can you be sure?".
My question is: does alcohol make a sufferer give into the thoughts that normally terrify and repulse him/her?
Thank you.
Paul's Reply: No.
Scary and understandable thought, but alcohol does not release some kind of "inner beast" in OCD, because by definition OCD is not an "inner beast". What it sometimes does is dull the obsessional thoughts (and any other thoughts come to that) so that you would be less bothered by them. A nice glass of something at the end of the day (preferably as part of a nice chat with someone who cares for you) is not a bad way of dealing with worrisome thoughts for many people.
Nathalie: What you have to remember is that recollecting details from 'the night before' makes most individuals more anxious because of the haziness about the details. Therefore, since OCD thrives upon uncertainty it is more than likely to pull out the 'alcohol card' to argue that you did, in fact, act upon these thoughts which terrify you.
OCD a teenage phase? from Beth
Subject:: OCD a teenage phase?
Do you think that OCD can be a teenage phase?
Paul's Reply: No, not really Beth. Some people "grow out of it" (sadly a minority) but probably because they found different ways of dealing with things.
OCD General question from Carolyn
Subject:: OCD General question
Hi
If you could only use one short reply, what one significant piece of advice would you give regarding OCD, that would benefit all sufferers, regardless of OCD type?
Paul's Reply: Don't give up your hopes and dreams! I'm going to cheat by going for a second one :) Be skeptical about how you believe the world (and your OCD) works; don't accept it, experiment with it to find out how things REALLY are.
Anxiety levels when resisting compulsions from Cathryn
Subject:: Anxiety levels when resisting compulsions
Throughout my various treatments for OCD, it has been stressed that during the period of 'resisting' compulsive behaviours eg urge to wash/check or ignore intrusive thoughts, the anxiety will initially rise, eventually peak and then fall. The skill is to withstand the period of anxiety until it eventually diminishes. However, in my experience I have never found the anxiety falls, in fact it just continues to rise until it becomes unbearable. My intrusive thoughts worsen, my tics (I also have Tourettes) start and I feel like I'm going to explode.
To explain briefly, I have received 3 courses of CBT all from senior/experienced therapists, been on a whole range of SSRI's and neuroleptic meds and suffer from both compulsions and intrusive thoughts. At times I feel I must be 'to blame' for not tolerating the response-prevention treatment and basically not very 'brave'. But I have tried desperately and I still never find the anxiety levels fall over time. I am now classified at 'treatment resistant' and am at a loss of where I go from here. New drug treatment options are being considered for me at present (IV Citalopram), but the feeling is that it is no use me trying CBT again.
Your opinion would be appreciated, particularly the issue of my anxiety continually rising and not peaking/falling. Are some people simply unresponsive to treatment?
Thank you, Catherine
Paul's Reply: Dear Catherine,
Again tough to answer in the abstract. In general, if your therapist
has got it right in the first place, anxiety will come down and very quickly.
A few things to note: there should always be preparation before exposure.
Usually this is the "cognitive" bit of OCD, where you and the
therapist try to get a "shared understanding" of how the problem
works. Any exposure is set up as an experiment, when you and your therapist
work out how things work, refine things in discussion and try again until
it is sorted out. Certainly, that's what I'd be trying to do with someone
in who anxiety/discomfort was not declining. The kind of things I'm looking
for are
Neutralising in more subtle forms (arguing with self, distraction); very
often these are things recommended by therapists who dont understand the
way the problem works. Mental arguing (e.g. trying to convince yourself
that nothing bad will happen is another favorite). Really, its anything
you are trying to do.
The other biggie is entertaining the idea of going back later to check/wash,
so just doing it at the moment. One of my favorite metaphors for OCD is
the bully. OCD threatens, then promises relief if you do as it says. Sometimes
it delivers in the short term. However, the playground bully may leave
you alone if you give money today, but is back for more tomorrow. And
more, and more..... So if you make a stand against the big b*****d, and
say "No, I will not give in!" but add "until later when
I get the chance to..." you get the worst of all worlds.
Key thing, tho' is to analyse what really happens when you try to resist.
Your therapist/s should be helping you with this, it is their job after
all!
With regard to the label; I really hate it when a person is classified
as "treatment resistant". There are a load of things therapists
use when they (the therapist) have failed, all of which are designed to
"blame the victim". You can call the sufferer treatment resistant,
a complex case, a treatment failure...and so on. In fact, it is the problem
that is resistant or complex, not the sufferer, and often because the
therapist failed to do the right thing. Often? Always, and I don't exempt
myself from that.
Not very brave? Also not correct. Brave means feeling fear but doing what
you have to do through gritted teeth. That sounds like what you have been
doing. Am I brave when I don't check my door? I don't think so, just fearless.
Fearless people are not brave.
Hopefully the senior/experienced therapists have been offering CBT, and
have expertise in OCD.
The feeling that it is no use trying CBT again would be viable if you
have had good CBT. The reality is that there is a lot of bad stuff about.
Can OCD be Cured? from Caramoole
Subject: Can OCD be Cured?
Hi, I’d like to ask whether you feel OCD can actually be cured? From my own experience I would err on the side of not. I have suffered from OCD for 29 years, I would say I have a very good knowledge and understanding of the condition, I do expose myself to all fears, and yet, although my OCD does go into remission it always returns, and seems to retain it’s ferocity. So I’d say I am a survivor of the condition but certainly not cured, I deal with it on a bout by bout basis which is an absolute nuisance to say the least.
Recently, one of our own members here returned from two weeks with you, for the Channel 4 programme. We have all been delighted that she considers herself cured, which is wonderful news. I sincerely hope she is but when you treat someone for OCD, do you consider it to be permanent or is there a tendency for it to return. I can see the treatment of physical compulsions being very successful using exposure and response methods, just as with any other phobic type of illness. I am less clear as to the treatment and continued success when treating Purely Obsessional OCD (as my own is). Despite constantly facing my fears, not carrying out avoidance etc, it has always retained some grasp on me, often hitting out of the blue in the midst of an otherwise good period, for no apparent reason.
As Pure ‘O’ seems to be a problem for very many sufferers, I wonder what your best tip would be for dealing with recurrent attacks. What am I/we doing wrong to allow it to remain a problem.
Paul's Reply: Yes.
Tempting to leave it at that, but I have a reputation for gabbiness to uphold ;-)
Some people can and do get rid of their OCD. When we work with sufferers
as part of therapy we agree goals; short, medium and long term. Short
term is stuff that will make an immediate impact and medium term is what
we are aiming for by the time therapy finishes. Usually that will include
some variant on "getting rid of the problem" ("cured"
is not my preferred term, as it suggests I do the work; in fact it is
the sufferer who does it. I can't cure anyone).
That leaves the long term goals, which are a crucial part of this in my
view. These are your hopes and dreams, many of which in most sufferers
have been stolen by the OCD. It is really really important to have a clear
view of what it is you are working for. Its OK to try to get rid of the
bad stuff, but what really matters is being able to get on with the things
which really matter.
"Pure O" is, in my view, no different in this respect. for
many people (and it sounds as if you are one) its not just a matter of
confronting your fears, its also a matter of changing the beliefs which
drive the anxiety/fear/discomfort and motivate the neutralising. Confronting
fears can (sometimes) change belief, and powerfully so. However, if its
just that specific belief then the next intrusion (thought/image/impulse/doubt)
will tap into more general beliefs. Hard to explain in the abstract, so
lets try a (simplified) example. If you believe that thinking means you
want to do it, that's not going to cause problems until you think that
you might (say for example) want to kill someone you love. By confronting
the idea of killing the one you love (very hard indeed) you may come to
realise that you wont do it. The general belief (thinking something
means you want to do it) is unchanged, so when an intrusion involving
having sex with children comes along, you get hit just as hard. So you
deal with that, which is fine, but along comes the next..... and the next.....
The general belief needs to be dealt with, and in the context of an understanding
of who you are, what your values are and so on.....and if that's needed,
that usually means a therapist who knows this problem and knows CBT. Such
a person has to help you to make sense of what's going on, so that you
can choose to change.
Hey, this is the first item, and I could go on forever, better save some
for the later ones.
The answer is still yes!
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