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Recently, I’m coming across questions similar to this one: “I see fellow students learning their subjects very easily, but me, I seem to have to put a lot of effort into learning things. For example, any concept for me is hard to grasp lately, and I have to study long hours to make learning material clearer. It’s like my memory is failing me. I have OCD, and I’m wondering if this plays a part in the mental blocks I’ve been experiencing.”

Okay, let’s figure this out by first considering memory. Psychology suggests that OCD (obsessive-compulsive disorder) may be seen as a result of an imbalance between long-term memory and short-term memory processes. Short-term memory relies on auditory and visual codes for storing information. Longer-term memories are the result of shorter-term memories which go through a process known as consolidation, and involves rehearsal and meaningful association. *

Obsessive compulsive disorder has two essential characteristics which are obsessions and compulsions. The first has a person struggling with intrusive thoughts that might be about religious, sexual or harming thoughts or contamination, symmetry and responsibility. The corresponding compulsions would include praying, reassurance, checking, also washing repeatedly and aligning objects.

What is rehearsal and meaningful association?

First, rehearsal is the re-assessment of information you’ve previously learned in furtherance of a later need to recall it. Meaningful association relates to the significance of what has been learned and correlates highly with other dimensions such as how well you form images in your mind and retaining them. Also essential, is (1) having a good command of the language you use when reading and delivering specific information, and (2) listening acutely to audible teaching and then recalling how this was expressed; for example, how a tutor conveys meaning by the tone of their voice, their choice of language, vocabulary, gestures… and so on. *

Now when it comes to OCD and the ability to retain information, it could be that the natural process of consolidation, noted in the first paragraph, is interrupted by intrusive thoughts and corresponding rituals, and more likely ruminations. For example, the brain’s thalamus acts as a kind of “relay station” whereby motor and sensory information (except smell) are received by it and projected to the cerebral cortex (responsible for the so-called higher mental processes of language, thinking and problem-solving – Arthur S. Reber). Dwelling on the thoughts holds you back on your studies, yet you erroneously think there is something wrong with your memory or that you lack the aptitude to learn well.

Given the nature of its role, it makes sense how the thalamus loops the same information to and from the cerebral cortex in those who have OCD. For many, this feels like a circle of never-ending thoughts with little brain space to study. Yet despite what you think, your aptitude to learn well is intact and your memory is very good.

Even still, worry about failing to absorb study material and thinking you haven’t fully grasped the concept of a specific subject can then bring on all kinds of threat-related thoughts in which prolonged ruminations further affect your study. For example, dwelling on negative thoughts like, “What about my future prospects?” “What if I fail my exam?” and “If I’m not able to study and recall information, what will my point in life be?”

So what can you do when OCD intrudes on your studies?

Well, first of all, when you are challenged, remember to…

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Student Tip Sheet – 7 Ways to Beat OCD and Pass Exams

HALF-PRICE SPECIAL OFFER: Carol Edwards brings fresh ideas to a student's laptop screen, or anyone who wants to help a student free their brain to think more clearly and confidently about their studies. The attention is on students who are troubled with obsessions and compulsions whereby one of the questions the author often gets asked, is: "I see fellow students learning their subjects very easily, but me, I seem to have to put a lot of effort into learning things. For example, any concept for me is hard to grasp lately, and I have to study long hours to make learning material clearer. It's like my memory is failing me. I have OCD, and I'm wondering if this plays a part in the mental blocks I've been experiencing." Carol Edwards answers such questions by discussing 7 ways to help students, which include deep sleep for improving memory, chunking for better problem-solving, tackling "just in case" scenarios, getting better at decision-making, and more! This material provides clarity for the student and comes with short question sections to strengthen the learning objectives. Access to this document (with a unique password into the learning zone) gives a student not only the chance to engage with the author but also gets them her valued appraisal of the 7 question sections that accompany the document. This is to build student confidence where they can get back to healthy study. This special offer document costs just £6.24, giving one month's access to the buyer. After the password link expires, it can be purchased again, and the buyer resumes as before. Individual students or groups around the world welcome - just click on the item number below to add more people and before paying the adjusted fee. Please allow 1-2 days for your WordPress code to arrive in your inbox. Thank you.

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By Carol Edwards 2016. Updated 2019.

* Source of reference: The Human Memory

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Do you have intrusive thoughts that make you think your partner is attracted to someone else or vice-versa? Do you worry endlessly that your partner will leave you for someone else, or that you should end the relationship? Do you ruminate on things like whether your partner still loves you, values you, cares about you?

Anyone can have doubts about whether the partner they are with is right for them, and usually, such doubts circle around one and the other’s values. For example, someone may develop insecurities about their mundane job because their partner’s occupation is on a professional level. Or one partner may find a celebrity attractive (blue eyes with blonde hair), and then the other partner may feel a little bit insecure about their own dark-haired brown-eyed looks. These are justifiable self-doubts because any person can feel confidence issues creeping in at times. Still, such insecurities are generally fleeting and are resolved by standing back and putting in some rational perspective.

However, when obsessions are involved, the uncertainties are clouded, given that the signals from OCD are inaccurate. Consequently, a resolve is harder to establish because the outcome points towards inconsistent conclusions. In which case, the brown-eyed brunette may develop an obsession with their looks, and may even dye their hair blonde; and the person whose attention is on which partner has the more dynamic career may find they’re suddenly lacking in confidence, become depressed and, if predisposed to OCD, it could bring on the appearance of relationship-intrusive thoughts. OCD tends to jump in on the heart of the problem, what matters the most, which is the partner’s values system – in the example given, it would be the quality of being desirable and the importance of job roles.

Basically, in relationship OCD, a person’s judgement of what is important in life spirals out of control which can negatively interfere with the relationship. This goes beyond their intelligible values, which they mould for themselves throughout life. People direct their paths and influence what happens by their qualities and faults and what matters to them. In a non-OCD relationship, for instance, certain habits are the norm, partners accept each other’s “ways” even if they moan about them now and then. Let’s say one partner likes to have a few nights out, and the other one prefers to stay home, this can cause one or two rifts, but not where these jeopardise each other’s values system (e.g., each agree it’s healthy to have time alone), and more importantly, the bond in the relationship.

The problem with relationship OCD, however, is that in a similar situation, such intrusive thoughts meddle with one’s belief system. Subsequently, this becomes a negative focus whereby the attention moves away from the healthy value that spending time alone is okay, instead, its paid to intrusive thoughts coming into the mind about infidelity – e.g., “If my partner wants to spend two or three nights out, why is this?”, “What if s/he’s lost interest in me, and is seeing someone else?”

Ambiguous situations

A lot of people who develop OCD feel challenged when coping with ambiguous situations. This is why checking is a typical compulsion for people on the OCD spectrum. Being sure about something means going through the “what-ifs” to prove or disprove whether there is anything legitimate to worry about, and then still being doubtful.

Having the confidence to live with uncertainty is a goal when recovering from OCD. High anxiety levels and compensatory rituals such as checking, reassurance, questioning and mental reviewing take over, and so it’s crucial to understand how these compulsions serve to offset the adverse effects arising from the intrusive thoughts. It’s also vital to grasp that counteracting trouble-making intrusive thoughts is short-lived – e.g., the anxiety relief is provided by giving into rituals, yes, but the problem bounces right back and continues to barge in and disrupt the relationship.

Solution

By systematically resisting the compulsions and learning to lean into associated anxiety, even in the face of fear, and until it reduces naturally, a person who has relationship OCD can gain the confidence to handle uncertainty while nurturing a healthy two-way bond.

When thoughts about uncertainty persist

Managing uncertainty is one thing, yet when a partner continues to ruminate on whether their relationship is compatible or not, then thinking errors may need to be addressed. For instance, some thinking errors focus on values, noted already. As an example, if you or your partner has strong political ideals and the other one doesn’t, then intrusive thoughts might make you erroneously believe you’re not meant to be together. Sharing and enjoying a harmonious relationship with inherent and learned differences is fine until unwanted thoughts cloud your thinking which makes you mistakenly think that having separate interests, different habits, distinct sets of beliefs, a contrast in job-roles and salary, mean your relationship is incompatible.

No matter how much someone obsesses or compares their qualities with their partner, they will never be satisfied with the outcome. Also, in whatever ways they seek reassurance and check for proof that having differences in beliefs or interests is okay, it will never provide them with consistent answers. This is because one doubt leads to another because none can ever be satisfied. Also, and as mentioned before, while giving into compulsions relieves anxiety, behind the veil, it tells the brain that the alarm bells that signal erroneous information about the relationship could be correct, and this is why the OCD cycle keeps going in a circle.

Proof

It’s not unusual to find yourself questioning your partner’s commitment to the relationship when intrusive thoughts creep in. As already discussed, the fears associated with obsessions put that extra strain on the relationship, and so it’s easy to think and reason emotionally how you might mistakenly “see proof” when rationally, there is no proof. Also, if there’s a legitimate concern, this might be blown out of proportion (catastrophising) when OCD intrudes on it, whatever it might be – e.g., a partner’s attraction to the celebrity with blonde hair and overreacting. Realistically, insecurities about relationships are addressed through active listening (counselling); while OCD fears are treated with cognitive behavioural therapy (CBT) and exposure response prevention (ERP).

Cognitive behavioural therapy and active listening

Cognitive therapy targets erroneous thinking, it can help you see things from a new perspective; the behaviour side of treatment (ERP) encourages you to resist compulsions to starve the obsession. Active listening, on the other hand, works on the basis that you talk about worrying thoughts, perhaps upsetting memories in the past, or maybe a recent distressing time in your life that may have triggered the obsession. Anything that is discussed can help reveal why you may have deeper level relationship insecurities.

Should partners be involved in therapy too?

Yes, inviting your partner can help both of you to follow through with ERP homework assignments that the therapist sets out in the CBT session. Most therapists are trained in core counselling skills that would incorporate the active listening part in therapy to address relationship problems with both partners, which is an added bonus for addressing deep-rooted beliefs.

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By Carol Edwards © 2018 Updated 2019

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How do I know I’m ruminating about an obsession relating to my OCD, and not just worrying, generally?

While worrying could be said that you are made to feel anxious about something verifiable that has already happened or could happen in the future; ruminating, on the other hand, is to compulsively mull or think something over at great length, usually about the obsessive-compulsive problem.

What are the solutions for both worrying and ruminating?

First, when addressing a worry, someone will likely use a combination of intuition while also reasoning with facts, and in which case, a satisfactory solution is usually found. Once the worry is solved, the person moves on. For pervasive concerns linked to generalised anxiety disorder (GAD), it might be a little more complicated. This is especially so when depression is involved, but again, ways to manage a problem can be worked on by generating helpful strategies.

However, when people ruminate, they tend to compulsively search for answers, mentally scrambling around for solutions, albeit unsuccessfully. A person will deliberate about lost opportunities, disappointments, if-only statements and regrets; also “shoulds” and “musts”, such as “I should have done this”, “I must do that” or “if only I hadn’t have done _____”. Sorrow, grief, what to do about this or that, how to protect oneself or others, and fear about the future and what it holds for them add to the problem.

Unfortunately, no matter how many times a person becomes distracted about the things that matter to them, they never seem to settle on any concrete answer that would generally help them move on, and so it goes on.

So what’s the answer?

First, and before you can start to put helpful strategies into place, it’s important to recognise when negative reflection is happening, especially when one’s repetitive thinking is about an obsession in obsessive-compulsive disorder. Therefore, it is particularly crucial to identify that while obsessions and ruminating both take place in the mind not to confuse the latter as an actual obsession.

Should an obsession be present then the ruminating will usually be seen as the corresponding mental compulsion related to it. If the obsessive thoughts are that harm might come to oneself or someone else, then the ruminating will usually be going over the “what-if” scenarios and fearing the worst.

By identifying that you are ruminating, you are, in effect, doing what you would do when you notice yourself doing any other compulsion. Therefore, the answer is to resist ruminating as someone would with any other compulsion, and in terms of starving any obsession. Exercising control once you become aware that you’re doing a mental ritual means you can learn to follow through by “shifting state”.

What is meant by “shifting state”?

This means being in the present, and using your five senses as you move your mind and body to something else or being mindful of what you’re already doing. For example, if you like the outdoors, you might choose to spend time in the garden, or the park, and be mindful of the scents, touch, sounds, and what you see. Having sweets in your pocket is helpful too as you can pop one in your mouth and mindfully direct your attention to the taste. Strong flavours such as mint or humbug are particularly useful.

But isn’t this like blocking obsessional thoughts, won’t ruminating just start up again?

No, because obsessive thoughts are involuntary and cannot be controlled, but behaviours can be controlled, whether mental or physical. And so in this instance, you would be stopping a negative response when you shift state, not trying to stop an obsession. In other words, you would acknowledge the intrusive thoughts are there, accept they’re there, and allow them to come and go while staying in the present with your mindful activity.

Will shifting state increase my anxiety?

It can do because moving away from any compulsion can increase discomfort, but this is normal because anyone in the grip of anxiety wants to run away from it as quickly as they can. Unfortunately, avoidance is not a long-term solution. The goal, therefore, is to rest with raised anxiety while being supported with your mindfulness attention on what you’re doing presently; also, having the confidence that you’re holding yourself up until the symptoms reduce in their own time, so it’s bearing with the distress and building a tolerance to it that counts.

How can I make sure I don’t go back to ruminating?

One useful tip is to convince yourself that any further ruminating will be given attention to in one hour and for a strict amount of time, let’s say 10 minutes only for mental review. It might be that when an hour passes you’ll have forgotten to come back and address the issue, or let it go. However, if after an hour has passed and you are hard-pressed to fall back into ruminating, then ask yourself where it will lead, and then persuade yourself to come back in another hour. The way out of this spiral is to be stubborn in training yourself to resist becoming preoccupied and, instead, becoming more in control of rationally prioritising your thoughts to help you find workable solutions.

I worry endlessly about being gay and mentally go over what-ifs, repeatedly. Is this ruminating?

Yes, the ruminating happens when you deliberate at length about the problem. This circular thinking usually involves self-questioning. For example, “How do I know if I’m gay?”, “When I looked at pictures of people of the same sex to prove or disprove my sexual orientation, I experienced a groinal sensation, what if this shows I am gay? When all questions have been exhausted, they start over again.

So would I shift state? Or would I do an exposure?

You can shift state and also do an exposure. Doing an exposure would usually be to gradually introduce yourself to same-sex people and allowing yourself to ride through associated anxiety. You might start by first by looking at pictures of people of the same sex in underwear, watching movies about sexual orientation, and then moving to real experiences, for example, by going to a swimming pool and observing attractive same-sex persons or going into gay bars and getting to know people. Both techniques effectively reduce obsessive-compulsive symptoms (you become less sensitised to your fear), and with practice leads to remission (fear habituation).

Summary

Solutions can usually be found for usual worries; also, problems that fit with a generalised anxiety disorder. The solution for ruminating differs in that obsessions are involuntary as opposed to ruminating, which is a voluntary behaviour to search one’s mind for answers that cannot be found in one’s mind. Since ruminating is a choice, when spotted, it can be resisted. Shifting state can help a person mindfully distract where intrusive thoughts are acknowledged, accepted and allowed to come and go while leaning into raised anxiety until it reduces naturally. Also, to reach remission or dramatically reduce the symptoms of OCD, a person would practise confronting their fears and resist doing their usual corresponding rituals to reduce anxiety. This is known as exposure response prevention, the gold standard evidence-based treatment for obsessive-compulsive disorder.

By Carol Edwards © 2018 Updated 2019.

My Misophonia by Carol Edwards

This educational document takes the reader through an interesting journey in which the author (Carol Edwards) explores personal accounts of living with Misophonia (hatred of sounds) coupled with obsessive-compulsive disorder. Researched information including proposed diagnostic criteria as a standalone neurological disorder for entry into the DSM-5 is added to this fascinating description of one's aversion to sounds, colours, smells and movements with the added detail of grief, sensory processing problems and more. This document comes with a 15-question homework assignment to reinforce the learning objectives and lists some important treatment goals. The article is approx 4,500 words priced at only £2 or currency equivalent. A unique password that links to this document is sent to the buyer's email address following purchase.

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The word “delusion” in obsessive-compulsive disorder explains the absence of insight, not fixed belief associated with psychosis. Insight and pathological doubt provide clues about how psychological treatment might work differently for each person on the obsessive-compulsive spectrum and show whether this treatment is likely to be useful or not.

Photo by Siva Adithya on Pexels.com How does a clinician assess insight?

This would usually be taken into account during assessment with the Y-BOCS II scale. If not, any signs would typically be revealed during treatment. The same goes for pathological doubt.

Explain a lack of insight during therapy?

Well first, intrusive thoughts or obsessions can be described as involuntary interruptions that get sandwiched between every-day regular thoughts. While intrusive thoughts interfere, they do not exist outside of a person’s awareness and do not convert to action. People who have good insight into their OCD know this, but have doubts about it.

So people who have OCD still desire certainty?

Yes, doubt versus certainty plays a significant role in OCD. A person’s search for reassurance serves only to strengthen the obsession, so reinforcing this concept in therapy is a must.

Why else is this concept reinforced?

Some patients convince themselves their fear has or will come true, even though the emphasis is that emotional reasoning strengthens those assumptions. They find it hard to grasp that feelings and guess-work are not factual evidence and thus miss the “threat” factor linked with the disorder. So it’s vital to help them understand the difference between emotion mind and rational mind.

What is the “threat” factor?

This is where a person perceives their problem as one of threat instead of worry. For example, when someone has a harm obsession, their understanding of the problem is based on an irrational concept. This links to over-importance of thoughts and catastrophising. Subsequently, emotional reasoning further clouds rational thinking and they tend to question their actual values.

Can you expand on that?

Yes. Someone who has harm OCD (or other disturbing obsession) shows their actual values, which is, paradoxically, that they care deeply about people. The problem is that they cannot get past the barriers that confuse them when their intrusive thoughts “say” otherwise. They feel pinned down by OCD, fearing they are capable of putting thoughts to action. It’s not so simple to eradicate fears despite OCD being a paradoxical disorder. They find themselves in conflict, going over the relentless doubts when trying to understand a concept that’s difficult to grasp, especially during heightened obsessive-compulsive episodes.

How can someone grasp this concept?

One example is known as The Theory A and Theory B experiment (Salkovskis & Bass, 1997). The person would look at their problem as worrying (theory B) about the thing that bothers them instead of fearing to be under threat (theory A).

How does this experiment work?

First, worry (theory B) is to feel anxious about something unpleasant that may have happened or could happen in the future; and threat (theory A) comes with “warning signals”. A person agrees in therapy to test out theory B by finding workable solutions to overcome their worry, thus removing the threat element. So on the subject of say emotional contamination fears, one suggestion is for the patient to observe others interacting with each other and noting down the different types of responses that occur in this type of situation, which allows for rational concept. An example of both theories might be:

Theory A: The problem is that I feel anxious when I’m interacting with people; it’s like they’re all infected with HIV and I’m terrified I will contract this disease even without person-to-person contact.

Theory B: The problem is that I care very much about interacting with people and the thought of contracting HIV from someone causes me great distress.

As noted, by working on rational concepts for theory B means the threat element (theory A) starts to weaken.

Is it true that false memory confuses insight?

Well, let’s say memory tends to play tricks for a person who has OCD. When this happens, they will ruminate at length, searching their minds for abstract recollections. However, while they might remember an existing memory, even if bits of that memory is lost, they cannot recall a vague memory because it never existed.

It’s essential, therefore, to work with the patient to locate the pieces of information that are true and filtering out the rest. As an example, let’s go back to the person who has a harm obsession. Let’s assume they were in the same area at a time when someone was hurt. Later, they might add to the memory a non-existent one in which they fear they might have been the one who harmed that same person. They have this fear because they were wearing a blue jacket similar to the person who was hurt. Learning to live with uncertainty would be reinforced in therapy.

So living with uncertainty is one of the factors in reaching recovery, right?

Yes, this is one of the factors that is involved in the treatment plan for OCD and works better for people who have good insight.

Can a person’s insight improve?

Sometimes. Cognitive restructuring can help a person alter thinking errors linked to faulty ideas, although some often lose sight of their new healthier beliefs because their need for certainty overrides this. Pathological doubt clouds insight and drives behaviours to prove obsessions right, which makes exposure response prevention (ERP) more of a challenge when they cannot grab hold of certainty. Improved insight can help someone know that while they want this type of assurance that living with uncertainty is better than feeling under irrational threat forever.

Can obsessions turn into delusions?

Yes, obsessions can turn into delusions and delusions can turn into obsessions. A person’s misconceptions in this instance aren’t to be confused with those seen in psychosis. For example, if insight into an obsession is poor/lacking then this shifts from overvalued idea to delusional belief; a belief in psychosis, however, is fixed and does not follow the regular OCD cycle.

For delusion in OCD, insight can be worked on with cognitive restructuring of thoughts to change the pattern or significance of those thoughts. When the delusion turns into an obsession, it shows that cognitive restructuring has illuminated insight, also exposure response prevention since practising exposures squeezes the obsession.

A new perspective, plus a reduction in symptoms, allows the person to comprehend the significance of false versus real events concerning the obsession and to see that all real events are separate from it. For example, it’s true that the person was wearing a blue jacket at the scene involving injury, but this does not make valid the perception, “What if I was the one who hurt the injured person”.

What else helps a person reach recovery?

Mindfulness techniques are helpful because these help someone do what I call the 3 A’s. These are to Acknowledge, Accept and Allow intrusive thoughts to come and go in the present without passing judgement, also when doing exposures since this technique helps build distress tolerance and leads ultimately to remission.

Summary

First, cognitive restructuring helps a person see their obsessions at a deeper level of understanding. They learn to see that managing uncertainty far outweighs the benefits of living with never-ending doubts and “what-ifs”. Subsequently, they figure out that when they agree to face their obsessions (exposures) and resist compulsions (response prevention) that this is an active process that eventually weakens their obsessions and aids in their recovery. When treatment comes to an end, they take with them a personal blueprint that details their new set of healthier beliefs together with behavioural/exposure strategies that worked for them during their course of treatment, and to prevent a full-blown relapse in the future.

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By Carol Edwards © 2018 Updated 2019

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First, guilt is an emotion that most people experience. For example, if someone lies, they may feel guilt. If someone steals, it’s likely they’ll feel guilt. If someone has deliberate unkind thoughts about someone, guilt might follow. The list goes on… you get the general idea.

Levels of normal guilt

Normally, unkind thoughts and misdoings tend to have a relationship in terms of the level of guilt a person feels. The intensity of guilt, however, does not usually preoccupy the person’s mind for too long, not in the general sense of things at least. Even on occasions when a person is likely to feel overly guilty for various reasons, such as having a fear of being morally bad for perceived indiscretions, they are still able to resolve the problem and eventually move on and let the emotion pass.

Guilt associated with Religious OCD

However, when religious or moral OCD plays a role in this otherwise natural emotion (guilt), it’s fair to say that it isn’t a fluke that OCD has found a person’s vulnerability about what matters to them most. As a result, their standards are “affected”. This is because misplaced guilt intrudes on the way they believe they should think, feel and behave according to their values, religion or other doctrines.

John’s normal guilt

Let’s take “John’s” situation as an example. His family is religious. They have brought him up to have strict moral standards. Still, when he was 15 years old, he had thoughts to steal money from his local church’s donation fund. One day he gave into those thoughts. Later that day he felt shame and guilt.

John’s guilty conscience followed with a series of what-ifs? For example, what if he went back into the church and the priest announced that he saw him steal the money? What if the priest were to tell his parents or call the police? There were lots of worst-case scenarios going on, and all tangible, because something really did happen for John to feel shame, guilt and regret.

Thou shalt not steal

Time passed, John grew up, and the event faded from his mind. However, one day he happened upon one of the Ten Commandments on Wikipedia while Googling something for his religious studies. The words “Thou shalt not steal” triggered thoughts about the earlier theft incident. The nature of what he did all those years ago started to play on his conscience. Thoughts crossed his mind about whether he should have owned up to stealing the money or at least prayed for forgiveness.

On reflection, John decided it would be better for him to put the theft incident to rest rather than dwell on it. He felt he could do this because deep inside he knew stealing was wrong and was sorry for that. He was aware that having a conscience was enough to know that he’d been dishonest and that this in itself was punishment enough. And so from this perspective, he was able to pray for God’s forgiveness, forgive himself and move on.

In the above example, you can see how, when OCD is separated from natural guilt, the “what-ifs?” are appropriate in this situation. The resolve for John syncs with the emotions experienced. Moreover, this one incident was a learning experience for him; he knew his true morals were good and stealing was something he knew he would never do again.

John’s intrusive guilt

Let’s say this time John experienced intrusive thoughts about the theft. After reading the commandment “thou shalt not steal”, imagine him being beside himself with guilt and shame. He’d confessed to his parents already, prayed with them for God’s forgiveness, paid back the money, repeatedly asked for reassurance, and yet a year later the problem persisted.

In an attempt to make the problem go away, he would conjure up good words to block the intrusive ones that made him out to be corrupt in the eyes of God. John didn’t quite understand why he had these thoughts and often asked himself “what-if” questions such as, “What if I’m not worthy of going to church?” “What if the priest gets suspicious of my thoughts? What if God thinks I’m not truly sorry for what I did?” “Should I go to confession again?” “What if God punishes me and sends me to hell if I don’t confess just one more time?”

Again, lots of worst-case scenarios going on, just like in the first example, but in this case, the “what-ifs” were hard to define. They were hard to define because intrusive thoughts have no substance. These thoughts had latched on to what mattered most to John. Subsequently, and despite the real-event theft, he failed to see that his intrusive thoughts were at odds with his true moral values, or at least doubted this.

Conscience

Time passed by, John grew up, and the intrusive thoughts had become less intense over time, and he was able to function well in all aspects of life. However, John happened upon a story in the newspaper of a man who’d been sent to prison for stealing from several Gospel Halls in and around his hometown.  This had him wondering again whether his conscience had been cleared, after all. He labelled himself morally corrupt and decided that perhaps “confessing” again could be the answer to relieving himself of the “guilt” and “shame” that he was experiencing all over again. 

The thought of being morally unacceptable was too much for him to cope with. Once again OCD had found its grip, and the frequency and strength of the obsession began to invade his mind. Subsequently, he felt urged to “tell” his closest and most trusted friend about his perceived “immorality” and felt a sense of relief because his friend reassured him that all was fine. However, it wasn’t long before he started to think that perhaps he should seek out reassurance by going to different priests and “confessing” what he’d done years before, and so it went on.

Exactly how did OCD play a role in this otherwise natural emotion for John? 

Earlier it was noted that usually, an actual misdeed has a reciprocal relationship with the level of guilt experienced. Yet, when someone has an OCD episode one feels intrusive guilt, not actual guilt. This is the part that is hard to define. In any case, a resolve can never be in accordance with the emotions experienced because the guilt is invalid; it’s an obsession as a result of an obsession.

For instance, and to put it simply, John had justifiably resolved the theft issue years before. This was through the rational judgement of character and forgiveness, meaning in the present his compulsion to “confess” was the result of an obsession about perceived immorality. In other words, since obsessions are untrue pieces of information coming into consciousness means his confession and all his other rituals would be inconsistent. The reason for this is that the real event is separate from OCD whether forgiveness and resolve has already taken place or not.

So what was the solution for John?

John learned in cognitive behavioural therapy that his intrusive thoughts were, and are, just that. Cognitive strategies helped him alter thinking errors that link to erroneous beliefs, such as, “What if God hasn’t truly forgiven me for stealing? (thinking error)… This will mean I’m evil and will go to hell (faulty entrenched belief)”. The behavioural part of therapy known as exposure response prevention helped John systematically resist giving into compulsions. With dedicated practice, his obsession weakened, and he found remission.

Summary

With new healthier beliefs people who have similar experiences as John place themselves in a better position to identify that their recently established praying, blocking, “confessing” and/or other compulsions no longer need to be given into. This is because the rituals only serve to reinforce and feed their religious or moral obsession. A secondary obsession (“guilt”) and fearing that one’s conscience hasn’t been cleared adds to the problem. Balanced perspective in cognitive therapy firmly addresses and resolves misplaced, intrusive guilt. Finally, systematically resisting ALL COMPULSIONS in exposure-response prevention builds distress tolerance and leads gradually to habituation.

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First, a phobia usually involves having a fear of spiders, dogs, fire, open or closed spaces, heights, animals, blood, or something else. People are affected usually only when faced with their specific phobia; yet, can generally switch off when their fear is out of sight.

Specific Phobia

A specific phobia is persistent and intense. There is a compelling need to flee or avoid the feared object, substance or situation. These are factors that are determined before the symptoms are classified a phobia. Also, confirming that the person’s fear is seen as irrational and not reasonable in the given situation.

Obsession

In comparison, people who have obsessions are usually never free from their fears, even though these don’t legitimately exist. For example, having a fear of harm coming to a loved one it certain items are not symmetrical, is an obsession. Subsequently, the corresponding ritual to “prevent” harm is to align the objects repeatedly. It’s these rituals that strengthen the obsession.

Obsessive Phobia

There is another factor to consider, which comes from Isaac Mark’s expression “obsessive phobia” which is not, as he puts it, ‘a direct fear of a given object or situation, but rather of the results which are imagined to arise from it’. While there is a distinction between a standard phobia and an obsession, an overlap can be noticed when a person shows signs of one and the other.

So let’s say a person fears spiders but doesn’t think about them when they are out of sight – this would indicate the norm for a standard phobia. For example, obsessive-compulsive symptoms seen in a person who has OCD is non-existent in the person who has a phobia. However, when someone who fears spiders repeatedly locks all windows and covers door gaps to avoid spiders getting into their home, the diagnosis might be better suited as “obsessive phobia” because obsessional behaviour is being used to counter the feared thing (Issac Mark). I, myself, have struggled with an obsessive-phobia; later, I’ll explain how I overcame this.

Another example is of someone who has a fear of high-rise buildings. This person doesn’t think of tall buildings when these are not in sight. But if this same person were to walk or drive a different route to work every morning, where the areas are flat, they would be using an avoidance ritual.

Treatment

In the same way cognitive behavioural therapy (CBT) and exposure response prevention (ERP) are both used to help a person reduce symptoms seen in OCD, the same methods are used to help people overcome phobias and also obsessive-phobias. Medication (SSRIs) and Mindfulness are also often integrated into the person’s treatment plan.

The cognitive side of therapy helps change the perception about feared things and exposure-response prevention means a person systematically resists giving into compulsions. For example, in graduated steps, the person who has an obsessive-compulsive fear of high-rise buildings would agree to walk or drive in areas where there are tall buildings. First with just one or two, and to sit in the car nearby and tolerate associated anxiety until it reduced naturally, and before going on to the next step, which might be to stand by the buildings; next, to go inside the buildings, and so on. The main goal would be to climb the steps of the buildings or to ride up in the elevator with much-reduced anxiety.

I dealt with my obsessive-phobia of spiders by initially agreeing not to cover door gaps and to bear with my anxiety until it came down. When my anxiety reduced to 30% on the distress scale overall, I was ready to tackle my next fear on my list of fears, which was agreeing to look at small spiders, then to hold them; next, I looked at larger spiders, then I held them; and finally, I was able to handle a tarantula!

Carol Edwards – Overcoming my fear of spiders

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First, guilt is an emotion that most people experience. For example, if someone lies, they may feel guilt. If someone steals, it’s likely they’ll feel guilt. If someone has deliberate unkind thoughts about someone, guilt might follow. The list goes on… you get the general idea.

Levels of normal guilt

Normally, unkind thoughts and misdoings tend to have a relationship in terms of the level of guilt a person feels. The intensity of guilt however does not usually preoccupy the person’s mind for too long, not in the general sense of things at least. Even on occasions when a person is likely to feel overly guilty for various reasons, such as fearing being morally bad for a particular wrongdoing or perceived indiscretion, they are still able to resolve the problem and eventually move on and let the emotion pass.

Guilt associated with Religious OCD

However, when religious or moral OCD plays a role in this otherwise natural emotion (guilt), it’s fair to say that it isn’t a fluke that OCD has found a person’s vulnerability about what matters to them most. As a result, their standards are “affected”. This is because misplaced guilt intrudes on the way they believe they should think, feel and behave according to their values, religion or other doctrine.

John’s normal guilt

Let’s take “John’s” situation as an example. His family is religious. They have brought him up to have strict moral standards. Still, when he was 15 years old he had thoughts to steal money from his local church’s donation fund. One day he gave into those thoughts. Later that day he felt shame and guilt.

John’s guilty conscience followed with a series of what-ifs? For example, what if he went back into the church and the priest announced that he saw him steal the money? What if the priest were to tell his parents or call the police? There were lots of worst case scenarios going on, and all tangible, because something really did happen for John to feel shame, guilt and regret.

Thou shalt not steal

Time passed, John grew up and the event faded from his mind. However, one day he happened upon one of the Ten Commandments on Wikipedia whilst Googling something for his religious studies. The words “Thou shalt not steal” triggered thoughts about the earlier theft incident. The nature of what he did all those years ago started to play on his conscience. Thoughts crossed his mind about whether he should have owned up to stealing the money; or at least prayed for forgiveness.

On reflection, John decided it would be better for him to put the theft incident to rest rather than dwell on it. He felt he could do this because deep inside he knew he had done wrong and was sorry for that. He was aware that having a conscience was enough to know that he’d been dishonest and that this in itself was punishment enough. And so from this perspective he was able to pray for God’s forgiveness, forgive himself and move on.

In the above example, you can see how, when OCD is separated from natural guilt, the “what-ifs?” are appropriate in this situation. The resolve for John is in accordance with the emotions experienced. Moreover, this one incident was a learning experience for him; he new his true morals were good and stealing was something he knew he would never do again.

John’s intrusive guilt

Let’s say this time John experienced intrusive thoughts about the theft. After reading the commandment “thou shalt not steal”, imagine him being beside himself with guilt and shame. He’d confessed to his parents already, prayed with them for God’s forgiveness, paid back the money, repeatedly asked for reassurance, and yet a year later the problem persisted.

In an attempt to make the problem go away, he would conjure up good words to block the intrusive ones that made him out to be corrupt in the eyes of God. John didn’t quite understand why he had these thoughts and often asked himself “what-if” questions such as, “What if I’m not worthy of going to church?” “What if the priest gets suspicious of my thoughts? What if God thinks I’m not truly sorry for what I did?” “Should I go to confession again?” “What if God punishes me and sends me to hell if I don’t confess just one more time?”

Again, lots of worst case scenarios going on, just like in the first example, but in this case the “what-ifs” were hard to define. They were hard to define because intrusive thoughts have no substance. These thoughts had latched on to what mattered most to John. Subsequently, and despite the real-event theft, he failed to see that his intrusive thoughts were at odds with his true moral values, or at least doubted this.

Conscience

Time passed by, John grew up and the intrusive thoughts had become less intense overtime and he was able to function well in all aspects of life. However, John happened upon a story in the newspaper of a man who’d been sent to prison for stealing from a number of Gospel Halls in and around his hometown.  This had him wondering again whether his conscience had been cleared, after all. He labelled himself morally corrupt and decided that perhaps “confessing” again could be the answer to relieving himself of the “guilt” and “shame” that he was experiencing all over again. 

The thought of being morally unacceptable was too much for him to cope with. Once again OCD had found its grip and the frequency and strength of the obsession began to invade his mind. Subsequently, he felt urged to “tell” his closest and most trusted friend about his perceived “immorality” and felt a sense of relief because his friend reassured him that all was fine. However, it wasn’t long before he started to think that perhaps he should seek out reassurance by going to different priests and “confessing” what he’d done years before, and so it went on.

Exactly how did OCD play a role in this otherwise natural emotion for John? 

Earlier it was noted that usually an actual misdeed has a complementary relationship with the level of guilt experienced. Yet, when someone has an OCD episode one feels intrusive guilt, not actual guilt. This is the part that is hard to define. In any case a resolve can never be in accordance with the emotions experienced because the guilt is invalid; it’s an obsession as a result of an obsession.

For instance, and to put it simply, John had justifiably resolved the theft issue years before. This was through rational judgement of character and forgiveness, meaning in the present his compulsion to “confess” was the result of an obsession about perceived immorality. In other words, since obsessions are paradoxical pieces of information coming into the consciousness means his confession and all his other rituals would be inconsistent. The reason for this is that the real event is separate from OCD whether forgiveness and resolve has already taken place or not.

So what was the solution for John?

John learned in cognitive behavioural therapy that his intrusive thoughts were, and are, just that. Cognitive strategies helped him alter thinking errors that link to faulty beliefs, such as, “What if God hasn’t truly forgiven me for stealing? (thinking error)… This will mean I’m evil and will go to hell (faulty entrenched belief)”. The behavioural part of therapy known as exposure response prevention helped John systematically resist giving into compulsions. With dedicated practice, his obsession weakened and he found remission.

Summary

With new healthier beliefs people who have similar experiences as John place themselves in a better position to identify that their recently established praying, blocking, “confessing” and/or other compulsions no longer need to be given into. This is because the rituals only serve to reinforce and feed their religious or moral obsession. A secondary obsession (“guilt”) and fearing that one’s conscience hasn’t been cleared adds to the problem. Rational perspective in cognitive therapy firmly addresses and resolves misplaced, intrusive guilt. Finally, systematically resisting ALL COMPULSIONS in exposure response prevention builds distress tolerance and leads gradually to habituation.

Visit my OCD Topics Store

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