OCD and Virtual Reality

Exposure and response prevention (ERP) therapy is the evidence-based psychological treatment of choice for obsessive-compulsive disorder. Basically, the person with OCD is exposed to his or her obsessions, encouraged to feel the anxiety, and asked to refrain from engaging in rituals (compulsions) to reduce the fear.

I hear from many people with OCD who say that while they understand what ERP therapy is, and even how it could be helpful to many people, they don’t think it would work for their type of OCD, and therefore they don’t pursue treatment. This is indeed unfortunate as ERP can truly benefit all those who deal with obsessive-compulsive disorder.

But wait a minute. What if people’s obsessions involve horrible things happening to those they love, or a fear of going to hell? What if their worst obsession is the fear of being involved in a fatal car crash? Certainly these are not obsessions we want to, or are even able to, expose ourselves to. How can ERP ever help someone with these types of obsessions?

I previously addressed this issue when I discussed imaginal exposures, which are based on imagining different scenarios as opposed to them actually happening. These types of exposures can be extremely helpful in certain cases. So you see, while OCD can be tricky, it can always be beaten. Sometimes you just need to be more creative than usual.

Speaking of creativity, researchers at Stanford University have been studying the use of virtual reality (VR) in the treatment of various brain disorders including OCD. They describe VR as using “computer technology to simulate physical environments, sights, sounds and other sensations to make the computer images seem more ‘real’.”

Now that could be quite an exposure!

“In illnesses such as OCD, a patient faces situations such as contamination fear,” Professor of psychiatry Elias Aboujaoude said. “VR provides a convincing atmosphere so the patient can expose themselves to the stimulus and gradually become desensitized to this fear.”

Dr. Aboujaoude believes VR can be effective but acknowledges it is not available to everyone. VR is also still typically associated with video games, and that perception might be a hindrance.

While the research at Stanford is new, the use of virtual reality in the treatment of OCD has been around for a while. In this 2009 NIH article the use of VR in the assessment and treatment of OCD is evaluated and discussed. The article is long and detailed for those who wish to read it, but the bottom line is researchers conclude that the use of VR does have value for those with OCD.

While the premise of ERP therapy might be simple, its implementation is not always straight forward. But we are smarter than OCD, and as I said earlier in this post, it can always be beaten. If you are willing to engage wholeheartedly in ERP therapy with a qualified therapist who understands the importance of imaginal exposures and possibly even VR, you will be on your way to a life of freedom from OCD.

from World of Psychology https://psychcentral.com/blog/archives/2017/12/02/ocd-and-virtual-reality/

Why Too Much Self-Control Can Be a Bad Thing

Self-control refers to our ability to restrain acting on momentary urges, impulses, and wants in favor of longer term goals. Who doesn’t want more of that? 

Most of us think that it’s important to have a lot of willpower, to be able to resist temptation. We all hope that we’ll be able to avoid giving into that impulse to eat more ice cream, keep ourselves from expressing anger at a loved one, or make ourselves finish an important project even though we don’t feel like it. And generally, self-control is a good thing. Society needs people with high levels of self-control, those who can inhibit their momentary desires, think about long term goals, and take planful action toward them.

What if we can have too much of a good thing?

So if a little is good, a lot must be better right? Or, could it be that there is such a thing as excessive self-control? New research suggests so.

This body of research shows that excessive self-control can actually be a problem for some people.  This is the central idea behind Radically Open Dialectical Behavior Therapy (RO DBT), a new evidence-based therapy for people who engage in excessive self-control, or, people who are “overcontrolled”.

Overcontrolled people are typically:

Conscientious and responsible	Risk averse and overly cautious
People who have a hard time relaxing and “taking it easy.”	Perfectionistic
People who have high personal standards, even if they feel like they can’t always meet them	Excessively rigid and rule governed
People who pay attention to details	Focused on details at the expense of seeing the bigger picture
People who tend to keep their true opinions or feelings to themselves until it feels like the “right time”	Mask their true, inner feelings
Reserved, taking a while to get to know	Aloof and distant in their way of relating to others

These patterns of maladaptive overcontrol result from a combination of hardwired, genetic and temperamental factors and family/environmental factors that serve to reinforce these ways of coping.

While being overcontrolled may serve some adaptive functions, it unfortunately tends to come at a high cost, particularly in terms of people’s relationships and sense of connection. Specifically, the behaviors characterizing overcontrol tend to interfere with the formation of close social bonds and, as a result, people who are overcontrolled typically suffer from strong feelings of loneliness. They may often spend a great deal of time around others, but walk away feeling disconnected, unappreciated, lonely, and often exhausted.

Since overcontrolled people are generally responsible, reserved people, they generally don’t garner a lot of attention, but instead suffer in silence. Most often they suffer with problems like chronic depression, anorexia, or obsessive-compulsive personality.

People who are overcontrolled tend to answer yes to questions like those below:

• Does it feel like no one really gets what it is like to be you, especially some of the closest people to you?
• Have you learned to mask, suppress, or control hurt and tender feelings?
• Is it hard for people to get to know the “true” you? Do you consider yourself reserved or shy?
• Do you pride yourself on your self-control and yet at times feel overwhelmed and under-appreciated?
• Is it hard for you to enjoy or even take downtime or to break one of your own rules? 
• Do you sometimes feel all alone, even surrounded by people, and no one would guess how miserable you feel on the inside?

Many treatments focus inward, attempting to help people better regulate their emotions, change dysfunctional thinking, or learn to restrain problematic impulses. However, RO DBT is based on the idea that people with excessive self-control don’t need to learn to work harder, think more correctly, or better restrain their emotions. Instead, RO DBT focuses people OUTWARD, helping overcontrolled people change the social signals they emit, so that they can engage in more flexible ways of engaging with others.¹ Overcontrol can severely disrupt the fluid and natural give-and-take that is part of relationships when they are functioning well. RO DBT teaches skills that help people relate more effectively with others so that they can change their relationships in positive ways.

Rather than applying more self-control, RO DBT teaches skills for being more spontaneous in social situations, how to take it easy, how to make true friendships, and how to activate the neurologically based brain systems that regulate more friendly and fluid ways of interacting with others. Other skills address the rigid thinking and perfectionism that can interfere with learning how to adapt to constantly changing life contexts.

So, can you have too much of a good thing? Research seems to say that the answer is yes, at least in relation to self-control.

Reference:

1. https://www.newharbinger.com/blog/lonely-apes-die%E2%80%94-new-psychotherapy-chronic-depression-and-anorexia-nervosa

from World of Psychology https://psychcentral.com/blog/archives/2017/12/02/why-too-much-self-control-can-be-a-bad-thing/

Talking to Your Children about the Threat of Nuclear War

On Nov. 29th, the Today Show reported on North Korea’s latest ballistic missile launch and then my 13-year-old son Tommy asked, “Is North Korea going to bomb us? Mom, is this going to be our last Christmas?”

I was struck by Tommy’s intelligence and lack of innocence in his startling inquiry. I was born in 1963, the year after the Cuban Missile Crisis, and grew up during the Cold War. But I would have never had the wherewithal to ask something such as this. Schools had stopped teaching duck and cover. I don’t think I even knew in junior high what a nuclear bomb was. The only hint I had that these types of weapons existed was the fact that my older brother had a poster on his wall which offered advice about what to do if a nuke bomb went off. It said, “Bend over and kiss your ass goodbye.”

Now, it’s completely different.

Just yesterday, Hawaii reinstated monthly nuclear strike siren tests for the first time since the Cold War. Back in August of this year, the government released information for what to do in the event of nuclear war. It seems we’re getting ready as a country to suffer an attack.

Your children, like Tommy, might be concerned about an international threat this holiday season. The usual activities of making cookies, decorating trees, buying and wrapping presents, singing holiday songs might be overshadowed by what to do in the event of a nuclear war. What do you say to them to calm their fears? To offer hope in this time of political uncertainty? Below are some sentiments you can remind your children of if they’re scared of being harmed this Christmas. (The tips are arranged for the youngest children to the oldest.)

First of all, tell them that the world is full of good things and not-so-good things, that we as human beings must deal with the positives that life brings as well as the negatives. Put it in their terms. You could say something like, “It is fun to experience the good life has to offer like playing video games in your mini-man cave with your best friend Aiden, but you sometimes have to experience bad things like bad dreams and accidents. Remember that time you fell out of the tree and had to go to the emergency room?”

Engage them any way you can. Start a dialogue about something difficult they went through and remind them that they got through it. Be optimistic. You need to engender positive feelings in the face of their understandable negativity.

Next, tell them that they have strong parents or a strong parent who will take care of them in dangerous situations. 

Tell them that they themselves possess great inner strength and can persevere in the midst of catastrophe.

If you believe in God, tell them to pray for peace.

After this, put the pen into action. Tell your children to write to their members of congress about voting for the Restricting First Use of Nuclear Weapons Act of 2017. If this is passed, presidents would be unable to unilaterally start a nuclear war without congress’ consent. For more information about this act, go to this website: https://peacealliance.org/petition-restricting-first-use-of-nuclear-weapons-act-of-2017/

Tell them there are steps to take before there is a bombing, such as creating an emergency supply kit and having a family emergency plan.

Finally, you can explain that part of being alive is living with uncertainty. We can’t predict what might happen next, but it’s important to live with happiness and vitality despite this fact.

In conclusion, if your child is afraid of an international threat this holiday season, offer them age-appropriate conversation so that they can air their fears. If they’re old enough, enlist them in writing their members of congress and helping you put together an emergency nuclear supply kit full of, among other things, water and food.

What should you do now? Write and send letters to your members of congress about restricting president’s power during wartime. Then, read what the government published about surviving a nuclear attack — https://www.ready.gov/nuclear-blast.

And try to have a happy holiday.

from World of Psychology https://psychcentral.com/blog/archives/2017/12/02/talking-to-your-children-about-the-threat-of-nuclear-war/

Psychology Around the Net: December 2, 2017

Happy Saturday, Psych Central Readers!

This week’s Psychology Around the Net covers the successes (more specifically, lack thereof) of the Mental Health Parity and Addiction Equity Act, how mental illness might be passed down from generation, the #speakthesecret campaign for postpartum women, and more.

Enjoy!

Health Insurers Are Still Skimping On Mental Health Coverage: Although it’s been almost a decade since the Mental Health Parity and Addiction Equity Act passed (an act that’s supposed to make it just as easy to get treatment for substance abuse and mental health problems), patients are still struggling to access treatment.

The Science And Psychology Behind How Tinder Works: “The promise of reward is a powerful motivator, and this system of seemingly random rewards encourages addiction.” (Basically, we’re all a bunch of B.F. Skinner’s pigeons.)

NIH Study of WWII Evacuees Suggests Mental Illness May Be Passed to Offspring: New research shows mental illness associated with childhood adversity might be passed from generation to generation — even when the child didn’t experience the same childhood adversity as the parent. Researchers don’t yet know why this happens, but some possible explanations include the parents’ behaviors changing (due to the adversity) or epigenetic changes (chemical alterations in gene expression, without changes to underlying DNA).

Nutritional Psychiatry: Emerging Evidence and Expert Interview: This interview with Felice Jacka, PhD of Deakin University in Australia, the International Society for Nutritional Psychiatry Research (ISNPR), and the Food and Mood Centre, tells us more about the influence our diets have on our mental health.

These Comics Capture the Silent Struggle of Postpartum Depression and Anxiety: Licensed clinical social worker, postpartum mental health author, and founder of The Postpartum Stress Center Karen Kleiman has launched the #speakthesecret campaign. With the help of illustrator Molly McIntyre, the #speakthesecret comics show the silent struggle of postpartum distress — the feelings of depression, anxiety, isolation, and guilt that postpartum women aren’t saying out loud.

Rick And Morty’s Dan Harmon Has Some Empathy and Wisdom for Anyone Suffering From Depression: Using Twitter, a fan asked Harmon for advice dealing with depression; his answer went above and beyond.

from World of Psychology https://psychcentral.com/blog/archives/2017/12/02/psychology-around-the-net-december-2-2017/

What Is a Mood Journal and Why Should You Keep One? (Includes Video)

 

General Transcript For “Mood Journal” Video

My name is Gabe Howard. I’m the host of The Psych Central Show Podcast, and I am also a person that lives with bipolar disorder. Managing bipolar disorder takes a lot of time, and people often ask me, “Gabe, what are some hints and tips to help manage my bipolar disorder? Or my depression? Or my mental illness?” Well, I keep a diary.

Let me tell you a little story because I think it is funny. When I was 25 years-old, and was first diagnosed with bipolar disorder, I went to therapy a lot. I was learning different things, skills, and a woman who kind of reminded me of my sister (she was my therapist), she said, “Gabe, you need to keep a diary.” And this just conjured up this idea of a 12 year-old girl in her room writing down who she loved in study hall.  I immediately just had this visceral reaction of like no, no, huh-uh!  I already talk about my feelings, I already cry too much. I want to hold on to some semblance of manhood. I am not keeping a diary.

So I kept a diary because I wanted to get well, and frankly, I thought it was a decent idea, but I cheated a little and called it a journal. Because journals are manly. That’s what I’ve decided. And still, 15 years later, I actually still keep a little mood journal. This is mine and I’m not going to show you the inside because it’s private and that would be rude.

General Instructions and Benefits for Keeping a Mood Journal

But, I write down things like how I slept the night before. And I write down what time I took my medication. And I write down what kind of a day I had. Did I have a good day? Did I have a bad day? Did I have an awful day? I write down if I experience any side effects of my medication. I just sort of write down some basic notes one day at a time about my day. And this allows me to do two really amazing things. Right now, I see my doctor about every three months. Three months is a long period of time to remember how I did the previous ninety days. And I noticed that previously, I would walk in and when my doctor asked me how I was doing, I would answer as of today. I could have had the best eight/nine days, but if, on the ninetieth day when I saw the psychiatrist, I was feeling bad, I would say, “Awful, I’m doing awful.” That’s just not good information. But now, I could pull out the mood diary, or the mood journal, whatever you want to call it, and I could say, “This was my ninety days: I had a little trouble sleeping at first. Here are some side effects that I had. Here are the number of good days: I had sixty good days and I had thirty bad days. And, frankly, the last thirty days have been pretty good. And the bad days were at the beginning.”

And this would give us real data. And that was great because I believe that it got me better care. Especially because I could only see my doctor for 15 minutes. But it had another great perk: see, mental illness lies. And whenever I felt bad, I believed that every day was bad. But I could pull out this mood journal and I could look at it and I could see, okay, in the last two weeks I’ve had ten good days and four bad days. That’s progress.

You know, in the beginning, right after diagnosis, it took a long time to see progress, because for me there was either sick or well. Sick or well. I couldn’t see the little victories in between. This documented little victories. Starting to write down that I had good days made me feel better. It just did. Even if there were only two good days in a sea of bad days. Two good days. Tracking this stuff matters. It was also incredibly empowering that I did something every day to help control my own destiny. It may seem stupid that writing something down would help in the way that it did, but it did.

Keep it simple. That’s what is really important here. It is all about keeping it simple so that you’ll do it day after day after day. It is a lot of data that matters. Because when you look back over thirty days you are going to start to see patterns. And based on those patterns you can make decisions.

Finally, when it comes to what things to track, work with your therapist, work with your doctor, work with your friends and family. Track the things that are important to you to get the data that you want. It is your tool. Own it.

Talkback: Share Your Thoughts About Mood Journals

In the comments section below, talk about your mood journal and how it has worked for you, the things that you track, the scale that you used, and how you introduced it to your psychiatrist. When I first heard about the idea of a diary for people with mental illness, I really did think my doctor was a quack. But I was wrong, and 15 years later I am still keeping it up. It is a very easy, simple, and useful tool. And it is one that I am proud that I still do today. It has been immensely helpful, and I think it will be for you, too.

My name is Gabe Howard. I am the host of The Psych Central Show Podcast, and I’ll see you next time.

from World of Psychology https://psychcentral.com/blog/archives/2017/12/01/what-is-mood-journal-and-why-should-you-keep-one-includes-video/

Navigating the Holiday Hustle and Bustle as a Highly Sensitive Person

The holidays are often a meaningful time for highly sensitive people (HSPs). But they also can be tough. For starters, there’s the overstimulation, according to marriage and family therapist Joy Malek: “overcrowded shopping, dazzling displays, and aggressive commercial advertising. HSPs take in more detail about their environments than most people, and while this can be overwhelming at any time, the crowded atmosphere of the holidays can be particularly fatiguing.”

The world also moves quicker during the holidays, Malek said. There’s more traffic, and people are more impatient. There are more tasks, more errands, more shopping trips. “We are in a constant state of nervous system arousal, running on adrenaline. Since HSPs have more responsive nervous systems than the general population, we feel this stress more acutely.”

“Symbolism is often important to an HSP, who may be eager to create a celebration imbued with meaning,” said Jean Fitzpatrick, a therapist in private practice in New York City. We’re also idealistic, and want the holiday season to be beautiful and memorable—which can lead to disappointment.

Because of our aesthetic sensitivities, we yearn to create stunning surroundings and amazing meals, Malek said. We might “have an ambitious vision for crafting and experiencing the holidays.” We might become perfectionistic and hyper-focused on the details. This can lead us to go overboard and run ourselves ragged.

Being a houseguest or having houseguests can be hard, too. As a guest, you have limited control over the structure of your day, Fitzpatrick said. As a host, your regular routine gets disrupted and you don’t have your usual downtime.

The holidays also can bring up painful memories and emotions. Maybe it’s missing a loved one who passed away. Maybe it’s a reminder of your difficult childhood. Maybe it’s a sharp awareness of how lonely you sincerely feel. According to Malek, “Since HSPs feel more deeply than the rest of the population, these memories and emotions can impact us profoundly.”

Below, Malek and Fitzpatrick, who both specialize in working with HSPs, shared how we can navigate these potential challenges.

Have realistic expectations. HSPs might feel deeply hurt if someone doesn’t like their gift or if younger family members roll their eyes at a specific tradition, Fitzpatrick said. They might think they’ve failed to create a meaningful holiday, she said.

“But a holiday is not something you stage.” Remind yourself that you can’t control disagreements between family members (and you’re not responsible for them), Fitzpatrick said. Remind yourself that the holidays have different meanings for everyone—“and even if people are arguing about politics or their dessert recipe, it’s an opportunity for connection.”

The same goes for rituals that you worked hard to create but didn’t turn out the way you wanted. The weirdness that happened might actually turn into a new holiday tradition, Fitzpatrick added.

Focus on a few traditions. Malek suggested picking two or three holiday traditions that are most important to you—and not stressing out about the rest. “Focus on the meaning of the traditions you choose, rather than accomplishing them perfectly.” For instance, instead of feeling pressure to make every single holiday dish from scratch, simplify or delegate so you can create more space for savoring connection, she said.

Rethink your shopping. To avoid overstimulation—crowds, traffic, noise—do your shopping online, Malek said. Also, “make peace with ‘good enough’ gifts, rather than striving for perfection.” Instead refocus on your relationships and on quality time with those who matter most to you.

Incorporate self-care into travel. Think about the ways you can reduce your stress and nourish yourself while traveling. Fitzpatrick shared these suggestions: If you live in a big city, when possible, avoid take offs and landings during rush hour. Arrive a day early so you can relax, instead of sprinting from a busy workday to a family dinner. Be very selective with your schedule. Take walks. Plan in alone time. If you don’t have a private space to sleep, consider staying in a hotel. Share your own holiday traditions with extended family.

Be picky about all activities. “Weigh the feeling of missing out against the reward of a slower pace, and more time to enjoy the activities you do participate in,” Malek said. In other words, be deliberate with everything you do. Reflect in advance about what’s important—and what isn’t. Avoid doing things simply because that’s what you’ve always done.

Feel all your feelings. Give yourself permission to feel whatever you’re feeling. Sometimes, the holidays spark sadness or anger or other emotions we think we shouldn’t feel. Malek encouraged readers to make space for these feelings, to feel them without judging or criticizing ourselves. Also, give yourself permission to “opt out of observing the holidays if doing so just accentuates the pain.”

Reach out and reconnect. We can feel especially disconnected and lonely during the holidays, and our automatic response might be to isolate. Which can make us feel worse. “Even if you are missing a loved one, or longing for a partner or family, be sure to reach out to those who are presently in your life,” Malek said.

Ultimately, the key in navigating the hustle and bustle as an HSP is to honor and respect your traits and tendencies. And remember that there’s a lot of meaning and beauty in the mess, too.

from World of Psychology https://psychcentral.com/blog/archives/2017/12/01/navigating-the-holiday-hustle-and-bustle-as-a-highly-sensitive-person/

Best of Our Blogs: December 1, 2017

No matter how much you want it, you can’t will someone to say the words you’ve always wanted to hear. Words like:

“It’s okay. You did the best you could.”

“I’m sorry. You deserved better.”

“What do you need from me right now?”

“I love you.”

Instead of putting ourselves in unhealthy situations for the chance that person will utter these words, we can simply and lovingly say it to ourselves.

While you’re busy navigating the season with all its expectations and family gatherings, do yourself a favor and speak those words of compassion and love to yourself. And then read our posts for more tips on self-love and self-care.

Things Abusers and Manipulators Say to Their Victims
(Psychology of Self) – These are the telltale signs you’re being manipulated by a toxic person.

10 Ways To Assess and React To a Selfish Individual
(Caregivers, Family & Friends) – Being around a selfish and/or narcissistic person can leave you feeling depleted. Here’s how to cope.

Go No Contact, Sh*t and Get Off the Pot
(Narcissism Meets Normalcy) – If you’re still spending time with your toxic narcissistic relative, this will wake you up.

Perfectionism: 8 Tools for Parents with Kids Afraid to Fail
(Stress Better) – You’re worried about your child’s fear of failure and anxiety associated with perfectionism. Here’s what you need to do.

Give Yourself the Gift of Self-Care This Holiday Season
(Happily Imperfect) – How do you get through one of the most stressful times of year? These seven tips will help you manage the holiday season.

from World of Psychology https://psychcentral.com/blog/archives/2017/12/01/best-of-our-blogs-december-1-2017/