Category Archives: Boss it Back

Defying OCD: What It Takes Isn’t What You Think

If you really want to defy OCD, and need to do it because it’s interfering with your life, and you have the skills to do it—is that enough? Will you be able to defy OCD if you’ve got all three working in harmony? No! It’s not enough.

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My sister who’s in her 50’s entered an Ironman last summer at Lake Placid. On this enormous day she had a stomach bug and blisters on her feet. An runner’s worst fears. Being a spectator at the Ironman is very stressful. You see people quit throughout the day because of blisters or cramping. As a spectator, hours pass between checkpoints so you have no idea how your loved one is doing. There’s an app that tells us when a mile marker has been crossed. But that doesn’t tell us much. Only that she’s behind. We were worried most of the 16 hours. My sister swam, bicycled and ran for a total of 16 hours that day. At different check points we cheered her on. Early in the day she looked like she wasn’t going to make it. Later in the day she didn’t even notice us at the check points. She was in some kind of trance, repeating the word “BELIEVE” over and over. With just minutes to spare, around 11:45pm she crossed the finish line. 

It only took a couple of days to get the Ironman tattoo
It only took a couple of days to get the Ironman tattoo

I asked her how she worked 16 straight hours like that with a stomach bug and blisters. She told me that she yielded and shrugged a lot. “This having to stop at the Porta Potty all the timeis not fun. It’s destroying my time. <shrug> So what, nobody said this would be fun.” “I’m so tired. <shrug> Well, who isn’t?” “I’ve got blisters on my feet. <shrug> So what’s new?” She wasn’t thinking like a victim, feeling like a victim or acting like a victim. She shrugged at every possible obstacle.

Here’s why I know determination is a mindset. I asked her if she felt determined to finish no matter what. She replied, “No I didn’t feel determined but I was determined.” You don’t have to feel determined to be determined. I told her I noticed she kept repeating the word, “believe” and asked her what she meant by it. She said, “I don’t know I just kept saying it. I was having a hard time believing I was going to finish. I just kept repeating it to stay focused.”

My sister wanted to complete this Ironman badly, she needed the success because she didn’t want to train for another, and she had the skill to do it since she trained for over one year. Her body was a lean mean fighting machine. But, focused attention and determination is what made my sister an Ironman. All the training certainly helped and the desire and need helped to motivate. But, what got her to cross the finish line was shrugging at anything that tried to steal her attention away from being determined.

This is day 28 of a 30 day challenge. Now that you’ve looked at your wants, needs and skills do you think it’s enough? Is it all you need to defy OCD? Can you accept the challenge to work on focusing your attention on defying OCD. Staying so focused that nothing distracts you from being determined? Let us know what you decide!

Do You Want to Defy OCD or Do You Need To?

Defying OCD takes focus. You have to be focused on your needs, skills and wants. One without the other is of no value. 160_F_69325513_kjUZc2oxEDA2PThOUDQUBt6kdGE8okMP

Need: What you have to do
Skill:   What you can do
Want: What you desire to do—based on purpose, and all your hopes and dreams

Need Without Want
I’m thinking of a young woman who has a contamination fear. There is very, very little that she can touch or use in her home. Her OCD has convinced her that if she touches anything inside the house she will contract an unpleasant, long-lasting virus. She is particularly aversive to anything her sister touches and maintains a 3 foot distance from her at all times.

Yet, she uses the same toilet her sister uses. She allows her skin to come in to contact with the same surface her sister’s skin touches. When asked how she manages this she answers, “Well, I don’t have a choice. I need to be able to use a toilet. But, I don’t have to use anything else in the house.”

This woman is focused only on meeting a basic need. It‘s a good example of how you can only get so far by doing what you need or have to do. If you’re not focused on your wants then your actions are based on needs not wants. Doing only what you need to do is not going to take you very far.

Skill Without Want
A lot of times when a person with OCD is stuck they’ll be reminded to use their skills. They’ve spent time in therapy and know how to defy OCD. But, they stopped paying attention, went on automatic pilot and got tricked by OCD. They’ve regressed and are neglecting important needs. A worried, but frustrated loved one says, “C’mon, Boss it Back! Use your skills!” And the person who’s stuck responds, “I don’t care about my skills. Nothing works. I don’t want to fight this fight anymore. OCD is too strong.”

Want Without Skill
It’s not enough to have the desire to Boss it Back. Just the other day a woman said to me, “I want to Boss it Back. I really want to. I don’t want to live like this. I want to be free. I want all my hopes and dreams to come true. I want it so bad. But, I just can’t do Exposure Therapy. I can’t do it. I want to do it. But, it’s too scary to even think about.”

Wanting, Needing and Having the Skills will take you all the way. All three work in harmony 160_F_61978411_WH1ljyTm5Au9EccRXTLYhIq7AU278gmUand need your attention. One without the other isn’t enough.

This is day 27 of a 30 day challenge. It’s important to focus on all three areas: Want, Need and Skill. Conduct an assessment of where you stand in all three areas. Does one area need more of your attention? Are you focusing on all three areas?

When Getting Tricked by OCD Hurts Those Around You

As soon as you’re not paying attention OCD will trick you. It sends a false alarm and you fall for it hook, line and sinker. And sink you 160_F_83900455_0qeY9fvzpIWBIIgb0D4NQ5qANsgmjXZado. How does this affect those around you and what can be done?

First, let’s not jump to conclusions. There’s a possibility that the side show playing in your head goes totally unnoticed by those around you. You could potentially be fully engaged in a conversation with friends or diligently working on a team project and no one can even tell you’ve got a side show playing. So let’s not jump to conclusions that they’re affected by something they don’t even know is happening.

Sometimes you think you’ve involved an innocent “victim” in one of your compulsions; like a checking behavior. A wave of guilt pours over you and swallows you up for hours. Yet, the person you purposefully or accidentally involved in your “check” is totally unaware of what’s occurred.

“I checked my son to see if he had any nervous reaction to me.” The son has no idea this occurred. This worry and guilt is another false alarm; compliments of OCD. How do we know this? Because the innocent “victim” is oblivious to your compulsive checking and you’ve been perseverating. If the innocent “victim” is going about business as usual, and you’re still stuck in thought about this, it sounds a lot like OCD. It’s time to Boss it Back.

Just a quick review: The best way to Boss it Back is to YIELD to OCD. Shrug. Agree. Practice: “There’s my obsession. Good, I need the practice.” Walk your worry through to the worst case scenario, like “He’ll never trust me again.” And excessively expose yourself to that fear.

But, what if you’re not managing the side show well? What if it’s not your imagination and you really are visibly unraveling and coming undone. They ask you if you’re okay. They can see your eyes are glazed over and you’re in an OCD trance. They can tell you’re in OCD land. Maybe you’ve gone so far to yell at them because they’ve interrupted a compulsion or refused to feed your OCD or leave you alone. Perhaps you’re mad because you want them to pay attention to your worry and they won’t! Maybe you’re running around in a panic, crying, screaming as if the end of the world has arrived. Worst of all maybe you’re in bed and you don’t seem to care about living your life. If it’s your solution to least affect your family by isolating yourself and hiding, you’re fooling yourself that this sets them free anymore than it sets you free.  

What can be done?

  1. Work harder at defying OCD. Show them you have a strong work ethic. As long as you’re putting in an honest day’s work of bossing it back, they will feel encouraged. You can be determined even if you don’t feel determined. Climb the hierarchy of exposures and be accountable. Tell them what you’re working on.
  2. Continue to make it a goal to get better at regulating your emotions. Practice makes progress. Download a 911 app to help you get off the emotional  rollercoaster. Since Dialectical Behavioral Therapy is all about regulating emotions I think an excellent app for this is called “DBT Diary Card and Skills Coach.”
  3. If someone is telling you that your OCD is affecting them, sit down together and talk about ways to progressively exclude them from your OCD. You might still want to feed your OCD but that doesn’t mean other people have to. The conversation would sound like this: “From now on I’ll open doors with my sleeve instead of making you open doors for me.” -OR- “I’ve been asking you for a lot of reassurance and it’s not fair to you. Let’s use a reassurance notebook and I’ll stop interrupting your day.”
  4. Ask them to help you Boss it Back. OCD is a big force to go up against. It helps to have someone on your side. Not to feed OCD but to remind you of your tools. Like this:  “When you notice I’m stuck could you say something like, I can tell you’re having a hard time. I know that you’re strong enough to get through this. What do you need to do to Boss it Back? What’s in your tool box?” Give them permission to walk away if you’re not willing to problem-solve and Boss it Back.

These are three very effective ways to keep your family and friends the least affected by your OCD. None of them are easy to do. It’s hard work to get better every day. It takes mindfulness, determination and practice. 

This is day 26 of a 30 day challenge. Do you need to work on any of the four strategies above? Which one? Is there something else you’re working on to keep family the least affected by your OCD? Let us know!

 

How to Choose What to Focus On Right Now

pablo-14A well trained mind can choose what it focuses on. Your mind can learn to pay attention (on purpose) to something very unsettling and let anxiety naturally unfold. You can learn to notice anxiety and let it come and go without judging, evaluating, or running from it.

Imagine observing, noticing, and paying attention to uncomfortable sensations, images, perceptions, and thoughts without reacting whatsoever. There is no effort to get rid of a thought. There is just the intention to “be” right here, right now in this moment. This is how you free your mind. It’s how you free your life from the chains of anxiety and OCD.

I notice new clients often wearing rubber bands on their wrists. I ask what it’s for and they tell me a former therapist or a book they’re reading suggested that when they have an unwanted thought to snap the rubber band and say, “Stop.” I ask them to throw the rubber band away. People tell me they’ve been told to picture a stop sign. I tell them to picture a green light.

If your intention is to stop an unwanted thought or sensation then the suffering will only continue. When having an unwanted thought it’s best to say, “There’s my worry. Good, I want this worrisome thought. I need the practice.” “There’s that sensation I don’t like. Good. I want this feeling. I need the practice.”

You aren’t the creator of your thoughts. You’re the creator of your experience. How you react to an unwanted intrusive thought determines how you will experience life. Your thoughts don’t define you. What defines you is how you react to something you can’t control.

You can’t control your thoughts. You can control how you react to them. Be a caring observer of your thoughts but don’t try to detach from them. Embrace the opportunity for practice. What we practice we get good at. Practice makes progress.

This is day 24 of a 30 day challenge. When you become aware of a thought that makes you uncomfortable say “Good there’s that thought. I want this thought. I need the practice.”

12 Ways to Make Your Brain a Lean Mean Fighting Machine

brainworkoutIn order to defy OCD the brain needs to be a lean mean fighting machine. There’s a lot of white matter that needs to be obliterated. The OCD brain has more than the average amount of white matter. White matter interferes with concentration and prevents the making of new memories. That’s one of the reasons the brain gets stuck. In order to get rid of white matter, you’ve got to take your brain to the neurogym.

It’s not easy to go to the neurogym every day but the pay off is undeniable.  Here’s how to obliterate white matter:

  1. Be determined to go to the neurogym every day. Remember, you don’t have to feel determined to be determined. Don’t let your feelings get in the way of going.
  2. Visualize what will happen if you go everyday. Make a collage of what you’re fighting for. Write out your cost/benefit analysis. What will you gain if you go to the neurogym and what will you lose if you don’t go.
  3. Make time for it in your busy day. You need about 20 minutes per day. (This doesn’t replace Exposure & Response Prevention. You need both!) Schedule when you are going to go to the neurogym. If you don’t schedule it, it won’t happen. When people say they don’t have time for all of this it’s not true. If you’ve got time for compulsions, you’ve got time for this! And remember, there is always someone busier than you finding the time.
  4. Stick to the plan. When you do what you say you’re going to do your quality of life improves. When you don’t meet your commitments you will think less of yourself. OCD is a big force to go up against so you need all the self worth you can muster. A simple way to stay positive about yourself is to do what you said you were going to do.
  5. When you are at the neurogym choose from any of the following 10 minute exercises:
    1. Juggle with bean bags, scarves, or any size ball. Start with one and work your way up to 3. It doesn’t matter how good you are at it. It’s the practice of it that helps. Watch YouTube videos for how-to instructions.
    2. Memorize a poem or song. Get a memory game app on your smart phone. Play memory games with your kids. Practice memorizing something.
    3. Take your trigger words and think of a neutral word that rhymes. Then think of a word that is associated with the rhyming word. Like this: germ: term: paper.
    4. Listen to a podcast or documentary and learn something new. Listen to Ted Talks.
    5. Learn to play an instrument. If you already know how to play an instrument, learn a new song. If you don’t have an instrument get the app Smule or Garbage Band.
    6. Meditate. Meditate. Meditate.
    7. Color. Get a coloring book or use an app like Colorfy.
    8. Read a Lateral Thinking puzzle book or use a Sudoku book or app.

This is day 22 of a 30 day challenge. Which of the above will you commit to doing every day to obliterate white matter and make your brain a lean mean fighting machine?

10 Ideas for Adding Variety to Exposure Exercises

facefearIf your using Exposure & Response Prevention here are some creative ideas for your exposure hierarchy:

Loop Tapes
Record your unwanted intrusive thoughts and listen to it in excess.

Sing
For she’s a jolly good _________. Fill in the blank with the thing you fear that you are or will become.

Different Language
Use Google translate or Babblefish and type out your worst thought and then translate it in several different languages. Read it out loud in a foreign language.

Magnets and Bracelets
Get a roll of magnets, cut it into pieces and then write words on them. Make sentences on your fridge using trigger words. You can do the same thing by making a bracelet using letters, formed into trigger words.

Chromatic Drawings
With stick figures draw out your fear.  IMG_1316-1

Role Play
Sitting back to back (not facing each other) have someone play the role of OCD saying all the terrible thoughts that are in your mind over and over and over. Practice saying to OCD, “OK Whatever.” Then reverse roles.

Newspapers/Magazines
Find images and make a collage of your worst fears.

Bookstore
Go to the bookstore or library and ask to be shown to the section you would usually do everything in your power to avoid.

Ink
Buy or make a T-shirt with trigger words or images and then wear it, even if only under another shirt. Using a marker write the letters of a trigger word on each finger, even if you jumble up the letters. Write trigger words on post-it notes and drop them in a mall parking lot.

Movie
Find a movie that has the content of your obsession. When you get to a triggering part of the movie, rewind and replay it in excess.

Exposure & Response Prevention (ERP): The #1 Mistake People Make

How do you know when ERP is successful?

Boss_It_1Now that you’ve built your hierarchy of fears it’s time to climb it. Starting with the easiest triggers to the hardest you’re determined to begin. You don’t feel like you’re ready but you start anyway.

It’s not helping. You feel overwhelmed. You feel worse. More afraid than ever. Why isn’t ERP working????

How do you know it’s not working? What’s your end goal?

I’ll know ERP is working when…

I’m not anxious anymore.
I stop thinking these thoughts.
The urges are gone.
I feel at peace.
I know for certain…

#1 Mistake
None of the above is the correct way to measure success. You’ll know ERP is working when you ARE anxious and not doing anything to fix it.

In fact you’re asking for more anxiety. You’re saying to OCD, “Bring it.” “Give me your worst.”

You’ll know ERP is working when you’re tolerating anxiety and living your life even though you’re anxious and having thoughts.

Wanting the thoughts, sensations, urges and anxiety to stop is your #1 mistake. This is only going to make you continue to suffer.

This is the first hierarchy to climb. It’s a mental Kung Fu hierarchy. It’s called “I Want Anxiety and A Lot of It.” or the “I Want to Feel Uncomfortable Forever” hierarchy. 

Make a hierarchy that has nothing to do with your obsessions. The list contains things that you know will make you anxious but not necessarily trigger your OCD.

Watch a scary movie and don’t cover your eyes.
Give the incorrect change to the cashier and don’t apologize.
Ask for a slice of pizza at McDonalds.
Start singing in the middle of the mall.
Call a department store and ask if they have a non existent DVD.
Ask for a job at the Apple store.
Say hello to someone who’s waiting with you in the check out line.

Your list will be unique to whatever makes you anxious and nervous but doesn’t trigger your OCD. Number the items on your hierarchy from easiest to hardest. Then climb this hierarchy hoping with all your might it causes you to be anxious.

You want to be anxious and you want it to last.

Go be anxious. Do it gladly.

11 Ways to Resist Compulsions

OCD is a trickster. That’s why every day with OCD is April Fool’s Day. Even if you conduct exposure exercises every single day of your life (which I highly recommend) you still can be fooled by OCD. It’s sneaky and will try everything up its sleeve to trick you into a compulsion or ritual.

OCD is scheming and manipulative—just like a drug pusher. All it needs to do is get you to buy one compulsion and you’re on your way to becoming a junkie. 160_F_78158575_49KcyvYHDAccjysVb1Lexz48ZSRh8V52The life of a junkie is a life of emptiness. All hopes and dreams vanish and the only thing you care about is your next fix. Your next compulsion.

Here’s how to tell the scheming manipulative trickster-drug pusher “NO THANKS”

  1. Recognize what OCD looks like. It’s the drug pusher offering you relief at no cost. “Just this one time. You’ll feel better.” In a room full of 100 people how many of them are worrying about what you’re worrying about? If the answer is not many then it’s OCD! Would you tell your friend to do what you’re doing? Would you take the piece of candy from the clown in the dark van? You’ve got to say, “I know you OCD. I see you. I know what you’re doing.”
  2. Make sure you’re doing exposures every day of your life. This isn’t optional. If the drug pusher sees you facing your fears you’ve got no weakness to be exploited. You have no problem that needs solving.
  3. You can’t talk your way out of buying a compulsion. As long as you’re talking to the drug pusher, you’re showing an interest in becoming a buyer. Don’t explain anything to OCD. Don’t answer any questions. Shrug at whatever OCD is selling. Would you really stop to explain to a drug pusher why you don’t think you need drugs?
  4. Practice focusing your attention for 10 minutes every day. Juggle or focus on something that is quite boring. You want your mind to wander. When your mind wanders, notice it and bring your focus back. Every time you bring your focus back you’re improving your mindfulness. The more mindful and aware you become the less likely you go on automatic pilot and act out of habit.
  5. Know what you’re fighting for. If you can’t figure that out because it’s been so long since you fought for anything, let your values drive your behavior. Write a script that basically says, “I’d rather take the risks (name them) than live like this (describe).”
  6. If you get a strong urge to do a compulsion—delay. Act like someone else for 15 seconds. Read your script. Think about what you have to lose if you give in. If you create enough space between the urge and the act, you can win.
  7. Give yourself permission to be anxious and uncomfortable. “This is unpleasant but I can handle it. I don’t need to fix this.”
  8. If you’re worried about something happening, remind yourself of the 100 people in the room. If they don’t have to do this compulsion, why should you? You might be unique but you’re not special! You don’t have some kind of special power! Stay in touch with reality! 
  9. Play mental Kung Fu. “Okay if that terrible thing happens so be it. I will gladly pay the consequence if it ever happens.”
  10. If you do get tricked, “recontaminate.” In other words, undo the compulsion by triggering yourself again and sitting with the discomfort.
  11. Make sure you’re eating enough protein, exercising and drinking plenty of water. This helps your brain to be a lean mean fighting machine.

This is day 15 of a 30 day challenge. Which of the above 11 ways to say “NO” will you work on? Choose and commit!

Are You Really Afraid of What You Think You’re Afraid Of?

160_F_68199924_qZUfTcFn0PcmSOb68IErHNTwHbm7iEJPWhat is FEAR anyway? False Evidence Appearing Real? That’s a cool acronym but is that really what fear is? And if we go with that acronym aren’t we engaging in some kind of compulsion? “It’s not real. It’s just my OCD. It’s just my thoughts. It’s just my imagination.” Say that enough and it sounds just like reassurance. And we all know that reassurance takes us down the rabbit hole.

What is there to be afraid of? Is it the thing in our mind worrying us? Is it really about that thing

I’m a recovering entomophobiac. I’ll always be recovering because I think about bed bugs all the time. I’m having to still “BOSS IT BACK.” In the past my fear of bed bugs caused me to avoid movie theaters, clothing stores, and hotels. I almost quit a teaching job once because a student told me the dorms were infested. I’ve slept in my car when I already paid for a hotel room. Once after years of bossing it back, I really got shook up. On the way to the hotel the cab driver told me the city was infested with bed bugs and he had just pulled one off his neck. OMG! OMG! OMG! I knew if I avoided that hotel room I’d only suffer. I had to BOSS IT BACK! I went in the room, slept in the bed and endured the pain. The next day I made sure I took a cab. By night time I barely thought about bed bugs, and when I did, I shrugged it off. To this day I’m still afraid. But I don’t let that fear stop me from doing anything I want or need to do. But, is it really the BUG that I’m afraid of?

Loss of Control
I’m not afraid of the bug itself. They can’t kill me. They can bite me but so do mosquitoes and I still go outside. I could even let a bed bug crawl up my arm. Here’s the kicker: AS LONG AS I COULD KEEP TRACK OF IT! I’m not afraid of the bug, I’m afraid of losing control. If I’m infested with bed bugs I’ve lost control of my whole life! In my mind it’s catastrophic. My home is no longer mine. My body has become a parasite’s vessel. I’ve lost complete control. 

The Process
I’m not afraid of the bug, I’m afraid of the process of decontaminating. The process of getting rid of bed bugs is life-less and time-consuming. My freedom will be taken from me and I’ll have to waste precious time cleaning and taking life. I won’t be able to spend my time doing what I want to do. I’m being forced to use my time on something I didn’t choose. I’m being forced to be involved in a mass killing. The process of getting rid of bed bugs is wasteful. I’m afraid of going through that process. I’m afraid of getting stuck rewinding and replaying the traumatic process.

The Outcome
I’m not afraid of the bug. I’m afraid of the outcome of the extermination. After spending precious time getting rid of the bed bugs, what if it doesn’t work? I’m afraid I’ll have to do it all over again. I’m afraid that I don’t know what the outcome will be. I’m afraid of the uncertainty and getting stuck regressing to a life of hyper-vigilance.

This thing in your mind that you’re afraid of—is just a story. Your fear is real, but what are you truly afraid of? Loss of control? The Process? Not knowing for certain the outcome?

This is day 14 of a 30 day challenge. Apply these 3 questions to your feared object or situation and see what you come up with.

By the way, here’s a much better acronym:

160_F_82457787_cvnBa9dK5gtm0wFZCChnhdJfjAWEcyA4

 

 

What’s the Purpose of Exposure & Response Prevention?

The most widely used treatment for OCD is Exposure & Response Prevention (ERP.)

ERP is very effective when done right. The reason it works is because it updates the brain. In the past I’ve used other words to explain the effects of ERP. I’ve said “ERP is like getting a front-end alignment” and “ERP works because it re-calibrates the brain.”

160_F_31090355_QcsNrNUmrhz8B7qKlCg2X592aBA4Vwxl

I recently received this tweet: “Recalibration is such a robotic word. Why do you think we apply inhuman words to ourselves?” While I don’t think we are robots, we sure can act like robots.

Studies suggest that 90% of what we do, we’re not even clear why we’re doing it. We have free will but without mindfulness we do only what the brain does by default:

1. Watch for danger and
2. Conserve energy.

If you don’t take your brain off automatic pilot your brain focuses on one thing: survival. Every single unwanted intrusive thought is about somebody’s safety. Every single mental act or compulsion is about reducing threat.

It’s all about safety and survival. Every time you resist a ritual or compulsion, you’re recalibrating or making tiny adjustments in the brain. Every time you expose yourself to a “threat” you are updating your brain.

Every tiny adjustment leads to an eventual rewiring of the brain. It takes time. Be patient. Engage in ERP and your brain will heal.

But, I digress and haven’t answered the question. Isn’t it inhumane to use a robotic word like “recalibrate” to reference humans? This never occurred to me and it would never be my intention to be inhumane.

I don’t think of OCD as a psychological problem as much as a neurological problem. How one reacts to OCD is psychological but the problem itself is faulty wiring within the brain. So that’s why I use mechanical terms I guess.

But, now that I know it can be hurtful I will certainly be more mindful of my choice of words. It just felt good to have one word that captured the science behind neuroplasticity (the brain’s capacity to change.)

If you’re keeping a journal answer these three questions:

What could you discover by confronting OCD and conducting exposure exercises?
How might you get stuck if you don’t engage in ERP?
How can you make it real and take action today?