Showing posts with label psychology. Show all posts
Showing posts with label psychology. Show all posts

Dialectical Behavior Therapy

Earlier, I discussed emotional control through the practice of Stoicism. This article about Dialectical Behavior Therapy (DBT) goes deeper into the 'reflective' stage of that process. DBT is a type of psychotherapy that can help you to manage your psychosocial pain points; like situations over which you have no control,  common trauma response of reliving serious trauma, other post-trauma maladaptive responses, ongoing circumstantial vulnerability caused by complex trauma, etc.

Complex trauma often results from prolonged exposure to distressing events, leading to intricate psychological effects that can manifest as C-PTSD. Individuals may continue to experience symptoms such as flashbacks, emotional disregulation, and difficulties in relationships. In this context, the general public's impatient assertion that such people choose to cling to the past, to not "let go" can feel overwhelming or even invalidating, because it overlooks the depth of suffering involved. However, DBT is a more empathetic and solutions-oriented response to the suffering. The DBT approach does not imply forgetting or minimizing the impact of trauma. Rather, its compassionate take on the 'letting go' idea suggests a shift in how one relates to those experiences to foster resilience and healing. 


Interrelated Core Principles of DBT (dialectics, validation, radical acceptance) for resetting your perspective and coping:

  • Dialectics: DBT recognizes that two seemingly opposing ideas can be true at the same time. The following examples illustrate how dialectics can be applied to complex and challenging situations, allowing individuals to hold multiple perspectives and work toward integrating other perspectives to have an overall more balanced approach. This is key because focusing on the negative extreme is a human default. In fact, it is a defense mechanism to prepare oneself for potential danger. Unfortunately, it is easy to become polarized in difficult circumstances by being hyperfixated on negativity. However, dialectics is a form of de-polarization and balance (and reminiscent of the purpose of the hermetic principle of polarity; ie to become depolarized). Dialectics demands your cognitive agility. On that basis, I remember the 2 of Pentacles tarot card ... and even 5 of cups tarot card that encourages you to recognize that; while 3 cups have indeed spilt, if you turn around, you will see that 2 other cups remain un-spilt behind you and a bridge is also there to the other shore. In short, rather than see circumstances as 'either negative or positive', DBT encourages one to see challenges from the 'negative AND positive' angles. So rather than feel stuck in feeling vulnerable, you may find ways to pivot situations to say “While I am vulnerable in this situation (negativity), I am also strong (positive)” or “while I am capable of taking care of myself (masculine energy), I also need support (feminine energy).” While discussing emotional control through stoicism, I mentioned that, during a painful stoic 'pause', exploit your brain's neuroplasticity. In other words, train your mind to use dialectical reasoning to form new neuropathways. Here are some more examples.
    • Accepting a traumatic past while preparing for change in the future
      • A person with complex PTSD may need to acknowledge their traumatic experiences are a part of their history, while also working towards creating safer circumstances for a more hopeful future.
    • Embracing vulnerability while maintaining self-protection
      • Someone who has experienced trauma learns to be vulnerable and open with others (the right people), while also maintaining healthy boundaries and self-protection strategies to ensure their safety and well-being.
    • Acknowledging powerlessness while taking control
      • A person in an abusive situation acknowledges their powerlessness, while also taking control of their own actions and making decisions to prioritize their safety and well-being. This includes the empowerment that learning DBT and creating new neuropathways provides.
    • Practicing self-compassion while holding oneself accountable
      • Someone with a traumatic past is self-compassionate by acknowledging that maladaptive responses (like PTSD, anxiety disorders, dissociative disorders, cognitive distortions, social anxiety & awkwardness etc) are natural responses to their circumstances, while also learning better ways of responding to stressors.
      • A woman may feel overwhelmed and helpless due to a chronic illness. Erotical acceptance involves acknowledging the reality of her condition, accepting the limitations and challenges it brings, and focusing on her response and coping strategies, such as self-care and seeking support, rather than resisting or fighting against the illness.
    • Accepting the need for support while striving for independence
      • Someone accepts that they require meaningful support (like therapy or support groups), while also striving for independence and self-sufficiency (researching and shadow working on their own).
    • Recognizing the complexity of emotions while simplifying self-care
  • Validation: DBT emphasizes the importance of acknowledging and validating painful emotions and experiences. I must stress that if you are among those without support systems, like family, mental health professionals, police and or legal remedial services, prepare to do this for yourself.
    • A lady who has suffered trauma validates her emotions, such as anger or sadness, while also learning to counteract the distressing cognitive distortions that occur as a consequence.
  • Radical Acceptance
    : Accepting reality as it is, not as you want it to be. You can neither change nor avoid the painful reality. This is a painful, hard pill type of skill that involves pulling the plug on hope of some resolution of undesirable situation. Example(s) of applications.
    • Toxic relationships. You now accept that your best efforts through overexplaining and overcompensating will NOT make a difference. These attempts never have in the past and never will. This is because the other party, abusers (whether narcissistic individuals or groups, their flying monkeys, and so on) will never stop the abuse. This is a no-holds-barred turning point of knowing that there is absolutely nothing more you can do or will try to resolve the situation. For instance, you will no longer live in hope that 'maybe after X happens, or if I just do X more, or accomplish X.' as it relates to relatives, professional colleagues, distinct social groups, and so on. Radical acceptance therefore means 1) grieving loss, often significant loss; such as hope of having a secure childhood, secure parent-child bond, meaningful friendship, marriage, acceptance in a community, working relationship, and fulfillment of dreams. Radical acceptance also means 2) you no longer hide in denial and are therefore consciously facing heavy emotions due to your loss.            Dr Ramani 'A painful look at narcissistic relationships. Radical acceptance' (above video)
    • Self-relationship. You now accept yourself fully, regardless of shortcomings, imaginary, real or set by society. This is a matter of unconditional self-love. Self-lovers see their 'imperfections' as elements of cherished uniqueness. In social circumstances, this involves not trading one's authenticity (which may simply be a difference from the social norms) to get approval from others. In other words, you are unapologietically yourself. Dr Femke Bakker used a fitting analogy of how loving parents would respond by encouraging their child who falters while learning to walk. Rather than be critical, shout at or condescend their child, they accept their child as she is in the present moment. They are patient, recognizing that their wish for a walking child will not happen overnight. This heart posture means they handle their child's daily struggle with empathy and compassion. Listen to her Ted Talk about 'self-gentleness (aka radical self-acceptance)', especially if you are driven to perfectionism in situations but are not performing perfectly. Since perfectionism is often a trauma response, the concept of self-gentleness is particularly important as you 'learn to walk' (thorny situations). Be patient with yourself. Example(s): being overwhelmed by simple tasks is not laziness but executive dysfunction; anxiety disorders is a symptom and not a reflection of your stupidity; open admittance of trauma response disorders that you had previously tried to hide through shame (by others); binging on your guilty pleasure is self-soothing / a search for a dopamine fix; neurodivergence is a symptom and not a reflection of your intelligence; etc. To be clear, this is not about being complacent with poor habits. Instead, it is a first step that can lead to positive change because openly acknowledging an issue is a way of bringing it to the forefront of your consciousness so that it can be resolved. Example(s): AA attendees usually openly introduce themselves as 'alcoholics' in group meetings in which they attempt a 12-step healing program.
    •   YouTube TEDx Talks video 'The power of self-gentleness | Femke Bakker | TEDxLeidenUniversity'
      YouTube short-form video by DoctorRue 'Radical self acceptance'
      YouTube short-form video 'Why you should practice radicatl self-acceptance'

How to apply DBT in your daily life 
Here are the 4 key components of any DBT practice. Since each component is customizable, own the design of your process so you can enjoy and remain committed.
  • Mindfulness: mindfulness practices emphasize the importance of being present and fully engaged in the present moment without judgment or distraction. Examples 
    • deep breathing, meditation (seated, guided, ecstatic dancing), progressive muscle relaxation, adult coloring books
    • Individuals with PTSD often experience flashbacks, which are intrusive memories that can feel as though they are reliving the traumatic event. Mindfulness skills can help you to stay grounded in the present moment. Examples. You can practice the “5-4-3-2-1 technique”. This requires you to focus on your 5 senses by identifying: 
      • 5 things they can see around them,
      • 4 things they can touch,
      • 3 things they can hear,
      • 2 things they can smell, and
      • 1 thing they can taste.
By focusing on these sensory experiences, you redirect your attention away from the flashback and back to their current moment, reducing the intensity of the trauma-related symptoms.

  • Distress tolerance skills. To describe this practice in short form; it is about accepting pain without unnecessary and additional suffering. This is achieved by using healthy distractions. These healthy destructions help you to select thought patterns that are better than ruminating and causing intense emotional suffering and to be clear healthy distractions are not the same as avoidance. Examples.
    • Self-talk in your head or allowed when triggered as by the news or when hearing about or from someone who caused you pain. 
      • I cannot change what has already happened. [Do not relive the painful moments trying to figure what you should have or could have said or done instead Develop some type of releasing, aka 'defusion', like imagining the memory as a black balloon that you release into the wind as you redirect your focus to something else, perhaps a white or colorful balloon with something specific .... Or you can focus intensely on the present moment.]
      • This moment is the outcome of multiple turns in the past do not agonize over 'what-if' scenarios like if you had just returned the call the night before, given x detail and so on.
      • Read about Mel Gibbon's What if it all works out mantra that frees her brain from focusing on only the worst, most catastrophic of multiple probabilities 
    • To cope with nightmares through Distress Tolerance Skills. self-soothing is a form of distress tolerance to cope with overwhelming emotions and situations without resorting to avoidance or harmful behaviors. This involves engaging in calming bedtime routine activities like:
      • taking a warm bath,
      • Listening to soothing music,
      • Practicing deep breathing exercises
      • Using aromatherapy
      • Declaring sleep time intentions 
    • In acute distress situations that might trigger dissociation, use these distress tolerance steps.
      • Step 1: Identify a distressing situation or feeling (e.g., feeling overwhelmed by memories).
      • Step 2: Use the “TIP” technique (Temperature, Intense Exercise, Paced Breathing) to manage acute distress:
        • Temperature: Splash cold water on your face or hold ice cubes; this can help anchor you to reality.
        • Intense Exercise: Engage in physical activity like jumping jacks or running in place for a few minutes.
        • Paced Breathing: Practice slow, deep breathing like 'box breathing' to calm the nervous system.

  • Emotion Regulation Skills: Strategies such as identifying and labeling emotions, understanding emotional triggers, and using coping skills to manage emotions.
  • Interpersonal Effectiveness Skills: Techniques such as active listening, assertiveness, and boundary-setting to improve communication and relationships.
    • Assertiveness in interpersonal relationships might help you if you fear rejection or misunderstanding (that might arise from expressing your needs or feelings). Use “I” statements to express your needs and feelings (ie versus'you' statements). Example; Instead of saying, “You never listen to me,” say, "I really need to be allowed to complete each idea without interruptions/ for someone to take action on XYZ / the direct communication I" or “I feel ignored when I share my thoughts but [describe the person's triggering behavior] like do not get any kind of response.” If the counter party is worthy, this approach is likely to be received as not blaming them.
    • Unapologetically set boundaries to prioritize your mental health while remaining being polite and respectful towards others. Example; say, “I appreciate the invitation, but I need some time for myself right now or I need time to think about that before committing or I needed the scores from your professional observations so I can keep track and really engage in my progress.” 
    • Assuming that the other person is worthy and has good intentions but does not yet understand how to meet your needs, say "If someone does x (like grab me suddenly), that makes me feel  unsafe because it triggers my anxiety.


Who Can Benefit from DBT:

  • People with post-traumatic stress disorder (PTSD): DBT can help individuals manage symptoms of PTSD, such as flashbacks, nightmares, and avoidance behaviors.
  • Anyone seeking to improve emotional regulation and relationships: DBT can be beneficial for individuals looking to enhance their emotional intelligence, communication skills, and overall well-being.
  • Those struggling with emotional dysregulation: DBT can help individuals manage intense emotions, reduce self-destructive behaviors, and improve relationships.


CONTENT RELATED TO DIALECTICAL BEHAVIOR THERAPY


Hermetic Principle of Mentalism

This is the 1st instalment of a 7-part series on the 7 hermetic principles of natural law. It is the single-most important of the 7 principles. It is necessary for the success of any of the other principles.


#1. Principle of Mentalism

"The All is Mind; The Universe in Mental."
Everything begins in the mind of God. Since you are a fractal of God, ie designed microcosmically in God's image, the same also applies to you. So everything starts in your mind as thought; ie everything like your achievements, material things, states of mind and so on. In other words, you need the appropriate mindset as a prerequisite for a desired outcome.

However, a critical thing to understand is that the word 'thought' refers to deep subconscious, NOT surface level conscious thought. Huge difference! Fear not, despite the depth of these thoughts, you can use your free will to change these subconscious thoughts with choices that you make at the conscious surface level. However, the choice needs to be an intention that is so profound and clear that it can drive you to engage all points of your trinity (mind, body and emotion) into manifesting your intention.

In other words, when you have implanted the thought (with emotion) of achieving something into your conscious and subconscious minds, your corresponding actions will follow naturally. 

Furthermore, you can also engage the superconscious mind, aka universal mind, which is the macrocosmic consciousness outside of what you perceive to be your egoic self. From time to time, the superconscious mind reveals itself to your subconscious and conscious minds in obvious ways through 'synchronicities', ie meaningful coincidences or rapid manifestations that sync with your thoughts or feelings like when you encounter someone or thing shortly after thinking about them, seemingly randomly. Every thought is like a seed you plant in the fertile grounds of the universal mindThe now famous double split experiment in Quantum Physics has illustrated that your potent conscious and subconscious thoughts can even influence the macrocosm. There is a supernatural connection between your individual mind and the rest of the universe. This is why hermetic magick rituals like magick circles connect with the 4 elements of reality and often start with the spiritual element of air (for the mind in the East), then fire (for action) and then water (for emotion). The dream state, which is just like a deep meditative state, is a microcosm practice session of how our minds can create and interact with external realities, physical and even superconscious. 

Regarding the famous "double slit experiment", the simple act of watching matter, even inanimate matter, can alter its behavior at the quantum level. The implications of this are endless as it shows that consciousness can alter reality. Just imagine; if the mere presence of observation can do that, your highly intentional consciousness can alter reality, even if you can not yet see how on a 3-dimensional physical level. 
The prerequisite for applying this knowledge, ie altering reality through your mind is to de-clutter your mind so that your mind is clear about its intentions. Needless to say, just like how your mind impacts the environment, beware; the environment also impacts your mind's strength of attention on creative intentions. Each element in your environment that somehow overstimulates and thereby fragments your mind must be excluded whenever possible, even if you can not or barely recognize the impact. Common examples include social media, advertisements at every turn, constant notifications, constant streams of information, people that bring drama to your life, even ostensibly irrelevant details. Unfortunately, these distractions (aka addictions) distance you from your creative essence, especially since many distractions subconsciously shape your beliefs according to the will of others. Research shows that these excesses can lower your ability to maintain focus. Over time, your mind loses its sharpness and clarity. This point can not be stressed enough. Without you realizing it, external influences may train you to accept wrong limiting beliefs regarding the possibilities for your life. You may miss opportunities for loving relationships, productive partnerships, ambitious projects and so on.

Ultimately, therefore, in the modern world of manipulative mental overstimulation, your power to shape reality comes from your ability to willfully focus attention towards creative pursuits. In other words, your creative endeavors are more likely to be successful if you can give them your undispersed, concentrated focus (because a scattered mind with unconsciously formed beliefs would be powerless over your reality).

'Distractions are the most effective means of control over man.' Aldous Huxley

Mental self-control is therefore a source of self-empowerment. You can use meditation to achieve it, whether you meditate in the form of clearing the mind or focusing on something like the breath, dance or other point (like the minutiae of an activity, like noting the 5 senses as you walk, eat or otherwise). Either way, meditation trains your mind to break from the modern-day cycle of erratic thinking and to remain present and under your control. This needs to become a habit because, as a practice, meditation is like physical exercise in that, over time, your mind gets increasingly strong to focus according to your will and, despite external influences.

Forms of meditation that encourage you to empty the mind offer an opportunity to reprogram your mind. You will invariably observe thoughts that interrupt your attempts to keep your mind empty. Take note of these thoughts ... with pen and paper for later analysis. This exercise allows you to spy on your subconscious mind and to recognize your predominant thoughts. This is very important because the programing in your subconscious mind largely dictates what you can actually manifest, irrespective of your conscious intentions. If you can be deep, honest and kind with yourself, you can do the 'shadow work', ie you can recognize and resolve limiting beliefs and fears that block your potential. As a sidenote, it is common to focus banishment rituals on warfare by others against you. However, it is better to also banish your internal blocks so as to raise yourself above the effects of external warfare, especially since it is a near inevitability as you advance towards ambitious goals. 

Meditation clears your mind to help you be a better channel through which Spirit can flow.

Meditation frequently is like physical exercise in that it strengthens your mind's ability to let go of thoughts that do not serve you.

Sometimes, it is necessary to objectively research ways of overcoming your limiting beliefs. You might even need professional help. You decide! Regarding, the next point is to reprogram your mind with emotion and creativity like visualization, situational enactment in which you play out your future role with fervor and ritual magick in which you allow yourself to connect more deeply with the universal mind. Feel the emotion of the new reality as if it has already occurred. This is important because these practices put you into a receptive state to 'see' the universal mind and to attract infinite wisdom (which can include working with ancient African ancestors bound under a similar covenant). 


How to (re)program your subconscious mind
  • Select intentions that will be the predominant thought on which to focus throughout the day and during daily meditation. Your subconscious mind can only handle your predominant or most intense thought. Catch yourself when you fall back into negative thinking: worries, fears and ruminations and then redirect your thoughts accordingly. Many people default to rumination over past negative experiences, like failures. The subconscious and superconscious minds listens. Remove as many distractions (or 'noise') as possible from your life. This makes it easier for manifestation to occur. 
    YouTuber Dr Tracey Marks' video 'Two things you can do to stop ruminating' explains that 
    rumination is strongly linked with (major) depressive and anxiety disorders. Unlike normal constructive analysis of past events to problem solve, ruminating thoughts are only repetitive, unhelpful and negative without any problem solving. Studies show that rumination mostly occurs when you are not actively focused on or thinking about something. Said in terms of brain science; your brain's 'default mode network' is more active. Looking on the bright side, treat rumination or any type of mild dissociative state (especially if it is very engaging to your senses, aka highly vibrational / manifestationalas a golden opportunity to see what your subconscious mind is REALLY up to.
    • Depressive rumination examples
      • Thoughts associated with feeling un-lovable like "They would not like me", "I can not find a partner that can truly appreciate all of my complexities".
    • Anxiety rumination examples
      • You relive or repeat past traumatic events in your mind. (It is much like re-experiencing, a key aspect of PTSD anxiety disorder, but in thought).
  • Adapt intentions to current circumstances. One reason that many people do not succeed at manifestation is that their minds can not see the possibility of their intended end goal. In other words, their gatekeeping conscious mind rejects the idea, thereby preventing their subconscious mind from ever receiving it. For instance, if you wanted anything, and set that intention without being ready to attract it, you are more likely to fail. Just imagine someone barely able to write and not having even a high school diploma but setting the intention to earn a PhD within 6 months. While people continue to break the mold, such a person is unlikely to be very prepared, even if the universe presents opportunities for full scholarships. Conversely, if you set more realistic intentions, realizing that you need some type of self development that will help you to attract, identify and keep what you want, you are more likely to succeed by giving your mind an intention that is adapted to current circumstances. In other words, you need to take the necessary baby steps.
  • Write down your plan for your mental state to tell your mind to take this process seriously. 
  • Use the right language. Set your intentions in the present tense as if they have already materialized. The subconscious mind is NOT good at the future tense. It just wants to slavishly deliver on your current program, however you set it. Ensure your wording does not suggest lack. For instance, do not say 'I wish I had' because your mind will recognize that you do not have it. Use powerful words like 'mastering', 'perfect' and so on.
  • Talk to your subconscious mind just before sleeping. During your 8 hours of sleep, your subconscious mind dwells on and integrates the various ideas of your day's life experience. One of the easiest way to slip conscious intentions into your sleep-state subconscious mind is by declaring the message to yourself as you are falling asleep. Example(s) of suggestions with which you may reprogram your mind include the following. I like the idea of creating my own deck of cards from which I can draw at bed time.
    • I am healthy
  • Repetition. Review your vision board as the first and last things you ponder on each day.
  • Incorporate your mentalism plan into your daily life. Meditate on the intention. During meditation, visualize and imagine the intention, engaging as many of your senses and emotions as possible. See article on the principle of vibration. In response to negative patterns (like rumination), follow an 'if-then' action plan for each type. For instance, you may decide that 'if you catch yourself ruminating about / dealing with trigger x, your remedial response will be to do y'. Remedial responses do not follow the one-size-fits-all model but usually include meditation, grounding practices, art therapy and the like. Learn more about 'rumination-focused cognitive behavior therapy / RFCBT'. As much as your current circumstances will allow, start to behave according to your new avatar. For instance, if your intention is to become a chef, start consuming educational content on culinary arts. If your intention is to be more abc, learn how to start incorporating as many of those traits. Whenever possible, jump into the role, even if this means impersonating someone who already embodies the traits you desire. Impersonation involves responding to situations like how that person would, ie rather than how you would ordinarily. Naturally, this requires you to have really analyzed that person in advance. This may also involve rehearsing and acting out scenarios in advance. Remember to be patient because this is a process. Specifically, at first, your old self image will continue to rule the show, attracting reflections of its existence in your life. However, over time, the balance will tip in the other direction towards your new self image. Calls to action: Write out your alternative / alter ego (specify your superpowers, objectives, triggers, future); reveal your alter ego / powers in everything that you do. 
    • YouTube video by Aaron Doughty '3 Steps to anchor your new self-image' speaks of first acknowledging your old self image so as to be clear of what you want to undo. For instance, do you have some polarity issues? He also speaks of using repetition so that the new persona sticks. For instance, several times daily, check in with yourself to ensure that you are consistently aligning yourself (through thoughts, words and emotions) to your new self-image. As part of your checking in process, imagine and visualize yourself in experiences that align with the new self image. Do so with imaginations of your 5 senses.
    • Many famous people have created alter egos as a strategy for becoming the best versions of themselves and to fulfill dreams. See YouTuber Jillz Guerin video on how 'an alter ego can change your life' (inspired by Todd Herman's book 'The Alter Ego Effect'). 
       


      YouTuber Ethan Schwandt's YouTube video 'The alter ego effect - Todd Herman (mind map book summary)'. This video speaks about the superhero Superman and Clark Kent in a very interesting way. He suggests that, while most people would likely think that Superman was the alternative ego to Clark Kent, it might be the other way around. Specifically, Superman was truly who this being came to the planet as. However, he selected an alter ego, Clark Kent for safety in a society, knowing that he could switch back to his true self when necessary. In other words, your superhero abilities are truer versions of your higher self. You must therefore tap into that version of yourself.
    • Bob Proctor speaks of "creating a new persona" (from Proctor Gallagher Institute YouTube video 'Write your new self image', 3:45 to 04:45). He did this by borrowing elements of different people he wanted to emulate. For instance, he admired a man who always dressed very well. While he had not yet had the finances to support dressing like that, he set in his mind that that was one way in which his new person would be. He admired another man who walked with calm confidence. He visualized himself walking that way. This was the way he eventually built the different aspects of his new self. He committed in action to honoring the new vision. For instance, regardless of how others dressed, he went out of his way to ensure that he was always the best or one of the best dressed people in any room.   
  • Example(s). Daily repeat affirmations like the following.
    • I am learning so much about field X is the adaptation from Please give me / I wish I had an expert in field X. Who knows, maybe you do NOT specifically need a PhD, just knowledge and certain opportunities to perform within the field.
    • Financial ease is on its way that allows me to focus on passions a and b is the adaptation from How can I ever get out of this financial set back? I do not know how
    • I am mastering [trait a], becoming expertly [trait b] [like Person A] is the adaptation from I envy Person A.
    • I am growing in gratitude for life (because I am developing myself in a,b,c ways) is the adaptation from I am tired of life.



  • Consider using accessories
    • Music with the 963 Hz frequency, aka the 'God frequency' or 'miracle tone' is considered useful for significantly raising your vibration which is key to manifesting positive circumstances and outcomes. 
    • Flutter breath meditation for manifesting your vision (using a vision board)
    • High vibrational foods
      • fermented sprouts, especially with brain health herbs likes parsley and cilantro. (Fermented) lentils are considered as 'brain food' and can also be added to sauerkraut. (sprouts, sauerkraut). I include as many brain foods as possible. Others include: mushrooms (especially if sun-exposed for a day to increase its content of vitamin D), fennel seeds and parsley.


CONTENT (THIRD PARTY INCLUDED) RELATED TO THE HERMETIC PRINCIPLE OF MENTALISM OF NATURAL LAW

Obsessive Compulsive Disorder OCD

Obsessive Compulsive Disorder OCD

Obsessive Compulsive Disorder or OCD is a mental health disorder that features unwanted thoughts and fears (ie obsessions), leading to repetitive behaviors (ie compulsions) that are extremely disruptive to one's life beyond the general population's  normal levels of obsession or compulsivity (ie a disorder). OCD may be understood as a disorder of doubt or uncertainty because it is based on sufferers trying to regulate something that is not necessarily true or highly improbable. Sufferers are therefore trying to make certain that they remove uncertainty.

In this post, I will discuss each of the 2 diagnostic required components of this disorder; obsession and compulsion.


Obsessions

Obsessions are recurring thoughts, images or urges. Unfortunately however, they are disturbing, unwanted and intrusive. In other words, the unpleasantness is unwanted. The person therefore feels that the obsessions are out of his or her personal control which renders feeling of some level of powerlessness. When OCD sufferers struggle with obsessive intrusive thoughts without a corresponding physical compulsion, the condition is referred to as "Pure O" (to mean only obsessions'). To be clear, pure O is NOT a different diagnosis according to the DSM5.

A very important feature of obsessions is that they trigger distressing feelings. Those feelings are usually related to fear, disgust, doubt or the idea that something must be done in a very specific way. Regardless, this distress triggers the fight or flight response. So rather than have a trigger like war or rape, the same trigger will have occurred within the minds of OCD sufferers.

Pure O sufferers feel particularly stressed because the thoughts deviate so much from their normal values and beliefs that they are fearful that something within themselves has changed and they may feel compelled to act accordingly. Pure O obsessions usually take the forms of thoughts about physical or sexual aggression, visualizations of inappropriate images and frightening impulses.  

Another feature is the repetitiveness of the obsession.

To be clear, they are irrational or based on low probability outcomes. For instance, while extra handwashing during the Covid-19 pandemic was based on a rational, probable fear of contracting the disease, a fear of contracting Ebola in most cities is not very probable. 

Common obsessions include the following. 

  • Contamination obsessions. Fear of contact with perceived contaminated things like body fluids (examples include urine, feces); Germs/disease (HIV, COVID-19); Environmental contaminants (asbestos, radiation); Household chemicals (cleaners, solvents) and Dirt.
  • Violence obsessions. These involve the fear of: acting on an impulse to harm oneself or others or; violent or horrific images in one's mind
  • Responsibility obsessions. Fear of being responsible for: something terrible happening (like fire, burglary, car accident); harming others because of not being careful enough (dropping something on the ground that might cause someone to slip)
  • Perfectionism-related Obsessions. Excessive concern about: things not being even or exact; not knowing or remembering; losing or forgetting important information when discarding something; performing tasks "perfectly" .
  • Sexual Obsessions. Unwanted thoughts or mental images related to sex, including fears of: acting on an inappropriate sex-related impulse; sexually harming or being aggressive towards others like children, relatives.
  • Religious/Moral Obsessions (Scrupulosity). Excessive concern with: offending God; damnation; and/or concern about blasphemy.
  • Other circumstance-related obsessions
    • Obsessions about death/existence (like excessive preoccupation with existential and philosophical themes, such as death, end times. 
    • Emotional contamination obsessions (like fears of "catching" personality traits, perceived level of luck of other individuals
  


Compulsions

Earlier, I mentioned that distress accompanies obsessions. The distress  needing more cleanliness, sense of moral responsibility to avoid doing something to harm others and so on are the driving motivations for compulsions. Compulsions are repetitive behaviors or thoughts that one uses to try to neutralize the obsession-related distress. A key feature is repetition. 

Ironically, OCD sufferers know that compulsions are only temporary fixes. However, without immediate alternatives, they rely on the temporary fix anyway, much like emotional eating, thoughts to cancel out the initial negative thought.

Common examples include the following.

  • repeatedly going in and out of doorways, even at the known risk of running late for important engagements.
  • re-checking the stove several times before leaving the house
  • re-checking that objects are set down correctly in their place, like a CD into the tray of a carousel.
  • scrubbing oneself until the skin is bruised.
  • nervous tics like eye blinks, nose twitches, grimaces, shoulder shrugs, heard jerks (ie simple motor tic-related OCD or 'tourettic OCD' but not really tourettes which responds to physiological triggers versus psychological ones)
  • refusing to drive or be driven for an accident. In such case, the fight of flight response is heightened.
  • re-checking safety packaging for contamination.
  • hand washing until the skin is dry or peeling
  • seeking reassurance numerous times about the safety of a route
  • thoughts to cancel negative obsessive thoughts


It must be stressed that the heightened sense of responsibility to neutralize the obsession is not only a key diagnostic feature but also an indicator that even sufferers have a strong conscience and are highly improbable of acting on obsessions like harming others. OCD sufferers obsess in fear that they will act on their bad thoughts (than humans all have). Others should therefore exercise care in considering obsessions as a potential for criminality. The difference between OCD sufferers and someone with an antisocial disorder is that the latter does not exhibit the second OCD component, compulsion (ie to neutralize the obsession). A criminally minded person may enjoy the obsessive thoughts and actually act on the obsession. Regarding pure O, I mentioned earlier that there may be no corresponding behavioral / physical compulsions. However, there may be cognitive compulsions. For instance, sufferers may ruminate, usually a lot more than usual.

Sometimes, when the obsession is not very well understood, it may be useful to consider that compulsions often correspond to specific types of obsessions. The following are common examples that might help in better understanding the obsessions and their underlying psychological challenges.


Obsession: ===========> Compulsion

Unsafety ============> Cleaning

Fear of bad situations ====> Repetition

Painful thoughts =======> Saying good thoughts



Obsession and compulsion must be disordered

Diagnosis requires that obsession and compulsion be disordered. 

In the population of non sufferers, using these terms, people speak of "obsessing" over something, like a new social media influencer and will never miss a single new episode. It is also normal for people to double check what they have done. However, these types of so-called 'obsession' do not meet the diagnostic criteria because they do not feature the 2 components. For instance, following the influencer and simple double-checking do not disrupt life as one can still easily meeting meet life obligations as normal, like work and other social situations. 

However, someone whose obsession and compulsion make them not only double check like normal but to re-check 3, 4, 5 or more times is disordered because these additional checks consume extra-ordinary amounts of time and ultimately disrupts their lives as sufferers always arrive late or other socially unacceptable behavior. Despite recognizing the risk of running late for engagements, sufferers prefer to perform their rituals.

For diagnosis, the DSM-5 requires 

  • observation of obsession, compulsion or both. In the case of 'pure O', ie only obsession OCD involves obsessive thoughts that are not followed by physical compulsions.
  • compulsion should be time-consuming
  • disorder must NOT be explained by physiological effects of substances or other medical condition
  • should NOT be better explained by another disorder 




Incidence & Triggers

OCD affects roughly 3% of the population and usually develops during childhood or adolescence between the sexes equally. Persons seeming most prone to OCD are those that are intolerant of uncertainty. It is likely that OCD is most likely during stressful periods (like starting a new job, moving country and so on). 

Stress of any type, positive or negative can trigger OCD.

Famous persons suffering with OCD include David Beckham, Howie Mandel and Howard Hughes.


Other observations
OCD sufferers often exhibit higher levels of irritability. This is because their minds are already very preoccupied with fears that their capacity for tolerance to manage the normal amount of irritation is compromised. 

If possible, sufferers may become avoidant of social situations  because of fear that their rituals will likely illicit ridicule from others. (Read about social anxiety disorder / SAD)


Treatment

Treatment involves the following, often but not necessarily in combination. The purpose of treatment is to return the sufferer to a normal life experience.

  • psychotherapy aka talk therapy that helps sufferers to better manager their thoughts. It is best to pursue this type of treatment with only persons that are specially trained and experienced, like OCD experts, persons registered on the directory of professionals with OCD expertise via the International OCD Foundation (OCDF)  website, directory of professionals via the Anxiety & Depression Association of America, the Advancement of Behavioral & Cognitive Therapy (ABCT). Even specialized OCD support groups may exist. Treatment often includes 
    • safe exposure therapy, ie the sufferer is exposed to the obsession to retrain the mind into recognizing the irrational nature of the obsession. This usually reduces the distress associated with the obsession. However, the gold standard is exposure response prevention (ERP) form of treatment. The therapy requires the sufferer to sit with their anxiety in a safe place until the anxiety can subside, with a diminishing effect similar to reviewing the same scary movie repeatedly, ie 'habituation'. Another approach is that sufferers may also be encouraged to attempt dissociating themselves from the obsession and then responding to it saying "no", "no, x will not happen", etc ... The aim of responding this way is to develop a internal voice that overpowers the obsession in time. Visualization is yet another approach. For instance, one may visualize the obsession as a passing cloud. These methods may be used alone or in combination. Yet another approach is called cognitive restructuring (video below) based on calling out one's cognitive distortions to oneself.
  • medication that slows down the over activity in the affected parts of the brain. 
    • Selective Serotonin Reuptake Inhibitors / SSRI



CONTENT RELATED TO OBSESSIVE COMPULSIVE DISORDER (OCD)

Trauma & Stressor Related Disorders

Trauma and stressors are associated with events that are very harmful or at the very least; fear inducing. Trauma is the shaken state your mind experiences as a consequence. 

Humans and normal social life have in-built resilience to handle difficulty. However, challenging events can overwhelm us sometimes, especially if the usual means of resilience and protection from recurrences, etc are lacking in some way or other. In short, personal reactions to trauma-inducing events vary widely. While some people may emerge unscathed from challenges, others may develop serious trauma.

There are numerous symptoms, the most common of which include the following.
  • Anger
  • Sadness
  • Fearfulness
  • Shame 
  • Denial
  • Outbursts
  • Headaches
  • Changes in eating patterns
  • Digestive problems
  • Sleep interference

In short, severe situations may develop into a trauma & stressor disorder like the following.


CONTENT RELATED TO TRAUMA & STRESS DISORDERS

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